Health Care Resource Utilization and Management of Chronic, Refractory Low Back Pain in the United States

Study Design. Retrospective analysis of inpatient and outpatient medical insurance claims data from a database containing >100 million individuals. Objective. The aim of this study was to quantify the health care resource utilization (HCRU) of nonsurgical treatments in the first 2 years after a chronic, refractory low back pain (CRLBP) diagnosis. Summary of Background Data. Patients with persistent low back pain (LBP) despite conventional medical management and who are not candidates for spine surgery are considered to have CRLBP and incur substantial healthcare costs over time. Few data exist on the HCRU of this specific population. Methods. The IBM MarketScan Research databases from 2009 to 2016 were retrospectively analyzed to identify US adults with a diagnosis of nonspecific LBP and without cancer, spine surgery, failed back surgery syndrome, or recent pregnancy. We required >30 days of utilization of pain medications or nonpharmacologic therapies within both the 3 to 12- and 12 to 24-month periods post-diagnosis. Annual total health care costs, costs subdivided by insurance type, and use of nonsurgical therapies were determined for 2 years after diagnosis of LBP. Results. A total of 55,945 patients with CRLBP were identified. Median total cost was $6590 (Q1 $2710, Q3 $13,922) in the first year, almost doubling the baseline cost; costs were highest for patients with Medicare Supplemental insurance, reaching $10,156 (Q1 $5481, Q3 $18,570). A total of 33,664 (60.2%) patients engaged physical therapy, 28,016 (50.1%) engaged chiropractors, and 14,488 (25.9%) had steroid injections. In total, 36,729 (65.7%) patients used prescription pain medications, most commonly opioids (N = 31,628, 56.5%) and muscle relaxants (N = 21,267, 38.0%). Conclusion. This study is one of the first to investigate the HCRU of a large, longitudinal US cohort of patients with CRLBP. These patients experience substantial health care costs. Contrary to LBP management guidelines, most patients used opioids, and several nonpharmacologic therapies were used by only a few patients.