Nonadherence to Clinical Practice Guidelines for Opioid Prescribing in Patients with Chronic Low Back Pain: A Pain Research Registry–Based Study

Introduction: This study measured the prevalence and impact of nonadherence to clinical practice guidelines (CPGs) that recommend using nonpharmacological and nonopioid treatments such as non-steroidal anti-inflammatory drugs (NSAIDs) before considering opioids in patients with chronic low back pain. Methods: Participants within the PRECISION Pain Research Registry provided data during the period from April 2016 through October 2021. The prevalence of nonadherence to CPGs was based on current or prior use of 6 common nonpharmacological treatments, NSAIDs, and opioids for low back pain. The primary outcome measures were low back pain intensity, back-related disability, and pain impact on health-related quality of life. Results: The prevalence of nonadherence to CPGs was 68 (18.0%) participants among the 378 participants currently using opioids. Participants having some post–high school education (OR, 0.41; 95% CI, 0.22-0.74) or at least a college education (OR, 0.26; 95% CI, 0.12-0.56) were at decreased risk of treatment that was nonadherent to CPGs in a multivariate analysis. Participants whose treatment was nonadherent to CPGs reported significantly worse clinical outcomes across all 3 measures (P ≤ .001; Cohen’s d range, 0.41 to 0.62). Conclusion: Up to one-fifth of patients with chronic low back pain may be prescribed opioids in a manner that is not adherent to CPGs, thereby placing them at risk for poor outcomes.