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Prescription of Nonsteroidal Anti-inflammatory Drugs and Muscle Relaxants for Back Pain in the United States

Luo, Xuemei, PhD*†; Pietrobon, Ricardo, MD; Curtis, Lesley H., PhD; Hey, Lloyd A., MD, MS*†

doi: 10.1097/01.brs.0000146453.76528.7c
Health Services Research
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Study Design. Secondary analysis of the 2000 Medical Expenditure Panel Survey (MEPS).

Objective. To examine national prescription patterns of nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants among individuals with back pain in the United States.

Summary of Background Data. There is a lack of information on national prescription patterns of NSAIDs and muscle relaxants among individuals with back pain in the United States.

Methods. Traditional NSAIDs, cyclooxygenase-2-specific (COX-2) inhibitors, and muscle relaxants were investigated. Individuals with back pain were stratified by socio-demographic characteristics and geographic regions. For each medication category, overall prescribing frequency was compared across different strata and individual drug prescription was analyzed.

Results. Traditional NSAIDs, COX-2 inhibitors, and muscle relaxants, respectively, accounted for 16.3%, 10%, and 18.5% of total prescriptions for back pain in 2000. Among individual drugs, ibuprofen and naproxen accounted for most of the prescriptions for traditional NSAIDs (60%), whereas two thirds of the prescriptions for muscle relaxants were attributable to cyclobenzaprine, carisoprodol, and methocarbamol. Prescription of COX-2 inhibitors or muscle relaxants demonstrated wide variations across different regions. Several individual characteristics including age, race, and educational level were associated with the prescription of some of the medications.

Conclusions. Neither traditional NSAIDs, nor COX-2 inhibitors, nor muscle relaxants dominated prescriptions for back pain. However, a small number of individual drugs were attributable to most of the prescriptions for traditional NSAIDs or muscle relaxants. The prescription of some of the medications demonstrated wide variations across different regions or different racial and educational groups. More studies are needed to understand the source of the variations and what constitutes optimal prescribing.

This study examined national prescription patterns of traditional nonsteroidal anti-inflammatory drugs, COX-2 inhibitors, and muscle relaxants among individuals with back pain in the United States. A small number of individual drugs were attributable to most of the prescriptions for some of the medications. The prescription of some of the medications demonstrated wide variations across different regions or different racial and educational groups.

From the *Center for Clinical Effectiveness and †Division of Orthopedic Surgery, Department of Surgery, and ‡Center for Clinical and Genetic Economics, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Xuemei Luo, PhD, DUMC 3645, Duke University Medical Center, Durham, NC 27710; E-mail: luo00003@mc.duke.edu

© 2004 Lippincott Williams & Wilkins, Inc.