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The Burden of Chronic Low Back Pain: Clinical Comorbidities, Treatment Patterns, and Health Care Costs in Usual Care Settings

Gore, Mugdha, PhD, BPharm*; Sadosky, Alesia, PhD; Stacey, Brett R., MD; Tai, Kei-Sing, MS*; Leslie, Douglas, PhD§

doi: 10.1097/BRS.0b013e318241e5de
Health Services Research

Study Design. Retrospective analysis of an insurance claims database.

Objective. To examine the comorbidities, treatment patterns, health care resource utilization, and direct medical costs of patients with chronic low back pain (CLBP) in clinical practice.

Summary of Background Data. Although the socioeconomic impact of CLBP is substantial, characterization of comorbidities, pain-related pharmacotherapy, and health care resource use/costs of patients with CLBP relative to non-CLBP controls have been infrequently documented.

Methods. Using the LifeLink Health Plan Claims Database (IMS Health Inc., Watertown, MA), patients with CLBP, defined using the International Classification of Diseases, Ninth Revision, Clinical Modification, were identified and matched (age, sex, and region) with non-CLBP individuals. Comorbidities, pain-related pharmacotherapy, and health care service use/costs (pharmacy, outpatient, inpatient, total) were compared for the 2 groups during 2008.

Results. A total of 101,294 patients with CLBP and controls were identified (55% women; mean age was 47.2 ± 11.6 years). Relative to controls, patients with CLBP had a greater comorbidity burden including a significantly higher (P < 0.0001) frequency of musculoskeletal and neuropathic pain conditions and common sequelae of pain such as depression (13.0% vs. 6.1%), anxiety (8.0% vs. 3.4%), and sleep disorders (10.0% vs. 3.4%). Pain-related pharmacotherapy was significantly greater (P < 0.0001) among patients with CLBP including opioids (37.0% vs. 14.8%; P < 0.0001), nonsteroidal anti-inflammatory drugs (26.2% vs. 9.6%; P < 0.0001), and tramadol (8.2% vs. 1.2%; P < 0.0001). Prescribing of “adjunctive” medications for treating conditions associated with pain (i.e., depression, anxiety, and insomnia) was also significantly greater (P < 0.0001) among patients with CLBP; 36.3% of patients received combination therapy. Health care costs were significantly higher in the CLBP cohort (P < 0.0001), reflecting greater resource utilization. Total direct medical costs were estimated at $8386 ± $17,507 in the CLBP group and $3607 ± $10,845 in the control group; P < 0.0001).

Conclusion. Patients with CLBP are characterized by greater comorbidity and economic burdens compared with those without CLBP. This economic burden can be attributed to greater prescribing of pain-related medications and increased health resource utilization.

Using an insurance claims database, this retrospective study evaluated the clinical and economic burden in 101,294 patients (47.2 ± 11.6 years; 55% women) with chronic low back pain (CLBP) relative to a matched control group without CLBP in clinical practice. Relative to controls, CLBP patients had more comorbidities and higher health care costs.

*Avalon Health Solutions, Inc., Philadelphia, PA;

Pfizer, Inc., New York, NY;

Oregon Health and Science University, Portland, OR; and

§Department of Public Health Sciences, Pennsylvania State University, College of Medicine, Hershey, PA

Address correspondence and reprint requests to Mugdha Gore, PhD, BPharm, Avalon Health Solutions, Inc., 1518 Walnut St, Ste 1507, Philadelphia, PA 19102; E-mail:

Acknowledgment date: October 25, 2010. First revision date: February 21, 2011. Second revision date: May 9, 2011. Acceptance date: November 14, 2011.

The device(s)/drug(s) that is/are the subject of this manuscript is/are not FDA approved for this indication and is/are not commercially available in the United States.

The Pfizer, Inc., funds were received to support this work.

One or more of the author(s) has/have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this manuscript: e.g., honoraria, gifts, and/or consultancies.

© 2012 Lippincott Williams & Wilkins, Inc.