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Relationship Between Opioid Use and Pain Severity Ratings in Workers With Low Back Pain

Cheng, Melissa MD, MOH, MHS; Thiese, Matthew S. PhD, MSPH; Wood, Eric M. MD, MPH; Kapellusch, Jay PhD; Foster, James MD, MPH; Drury, David MD, MPH; Merryweather, Andrew PhD, CPE; Hegmann, Kurt T. MD, MPH BackWorks Study Team

Journal of Occupational and Environmental Medicine: October 2019 - Volume 61 - Issue 10 - p 836–840
doi: 10.1097/JOM.0000000000001673

Objective: The primary goal of this cross-sectional analysis was to determine the relationships between self-reported low back pain (LBP) ratings and use of opioid medications.

Methods: At baseline, subjects completed a computerized questionnaire. Structured interviews were conducted by residents or certified therapists under the direction of board-certified physicians.

Results: There was a statistically significant nonlinear relationship between lifetime prevalence of worst LBP rating (0 to 10) and lifetime prevalence of opioid use. Those with a low pain rating for worst lifetime LBP and those with high LBP ratings were significantly more likely to have been prescribed opioids. Surprisingly, those with moderate pain ratings were the least likely to have used opioids.

Conclusion: This study found a higher use of opioids between workers with low and high severe pain rating then those with moderate pain. We also found an increase of opioid use for severe pain.

Rocky Mountain Center for Occupational & Environment Health, Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah (Drs Cheng, Thiese, Wood, Merryweather, Hegmann); Occupational Science & Technology Department, College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Kapellusch); School of Rural Public Health, Texas A&M University Health Science Center, College Station, Texas (Dr Foster).

Address correspondence to: Melissa Cheng, MD, MOH, MHS, 391 Chipeta Way Suite C, Salt Lake City, UT 84108 (

This study has been funded, in part, by grants from the National Institute for Occupational Safety and Health (NIOSH/CDC), 1 U 01 OH008083-01, and NIOSH Education and Research Center training grant T42/CCT810426-10. The CDC/NIOSH is not involved in the study design, data analyses, or interpretation of the data. Additional sources of funding include the authors’ universities and other, noncommercial resources.

The authors have no conflict of interest.

Copyright © 2019 by the American College of Occupational and Environmental Medicine