Trends in Nonsurgical Interventions and Analgesic Medications for Low Back Pain: A Large Claims Database Study in Japan.

BACKGROUND

Low back pain is treated using a multidisciplinary strategy that includes several nonsurgical interventions and analgesic medications. However, trends in nonsurgical interventions and analgesic medications used in patients with low back pain remain unclear. This study aimed to investigate trends in nonsurgical interventions and analgesic medications among patients receiving nonsurgical interventions.

METHODS

We conducted a retrospective cohort study using the DeSC database (DeSC Healthcare Inc.), which contains health insurance claims and health checkup data of approximately 11 million patients in August 2021. We calculated the age- and sex-adjusted rates of nonsurgical interventions and the proportions of analgesic medications used in patients who underwent nonsurgical interventions for chronic low back pain from 2015 to 2020. All trends were analyzed using the Cochran-Armitage and Jonckheere-Terpstra trend tests.

RESULTS

The rate of nonsurgical interventions tended to increase from 1.79 to 4.21 per 100 person-years between 2015 and 2018 and declined slightly to 3.83 per 100 person-years in 2020. Nonsurgical interventions, including spinal cord stimulation, demonstrated a significant increase (p = 0.01), whereas procedures such as epidurals did not show a statistically significant increase (p = 0.19). The age-adjusted rate in females was higher than that in males after 2016. The sex-adjusted rate in patients aged ≥ 60 years showed an increasing trend. Nonsteroidal anti-inflammatory drugs were mostly used among patients receiving nonsurgical interventions; however, the proportion decreased significantly during the study period (p < 0.001). The proportion of patients using opioids was about 23%-30% and also decreased significantly (p < 0.001). The proportions of patients using acetaminophen, antiseizure medications, serotonin noradrenaline reuptake inhibitors, and tricyclic antidepressants increased significantly.

CONCLUSION

The present study demonstrated an increasing trend in nonsurgical interventions, with a peak observed in 2018. Among them, interventions including spinal cord stimulation showed a significant upward trend, whereas interventions such as epidurals did not exhibit a statistically significant increase. There was a declining trend in the use of nonsteroidal anti-inflammatory drugs and opioids among these patients. These findings may inform the selection of therapeutic interventions for managing low back pain.