Neighborhood socioeconomic status and receipt of opioid medication for new back pain diagnosis
Open accessAbstract
BACKGROUND: Although treatment for new back pain is heavily guideline driven, deviations occur frequently. Neighborhood socioeconomic status (nSES) may contribute to these deviations. OBJECTIVE: Determine whether nSES is associated with type of treatment provided for patients seeking treatment for new back pain in primary care clinics. METHODS: This retrospective cohort was conducted in academic internal and family medicine practices. Data were examined from the Primary Care Patient Data Registry. Eligibility criteria included age ≥18 years, free of HIV and cancer, and presenting to primary care with a new diagnosis of back pain, resulting in1646 patients included. Patients' nSES was determined using ZIP code and calculating a validated index of 7 census-tract variables. Multinomial logistic regression was used to measure the association between nSES and 3 treatment outcomes compared with no pharmacologic management. Outcomes included opioid prescription, nonsteroidal anti-inflammatory (NSAID)/muscle relaxant prescription, or combined opioid/nonopioid treatment within 90 days of initial presentation. Covariates included age, sex, race, high clinic utilization (HCU), depression, anxiety, substance use, obesity, comorbidities, smoking, number of pain conditions, and physical therapy (PT) referral. RESULTS: The cohort was 67.9% female with an average age of 55.72 years (Standard Error [SE] = 0.387). Compared with no pharmacologic treatment, individuals in the low nSES group had 63% higher odds of receiving an opioid only compared with the high nSES group (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.01 to 2.62). There was no significant association between nSES and odds of nonopioid or combined treatment compared with no pharmacotherapy (OR, 1.17; 95% CI, 0.97 to 1.50), (OR, 1.09; 95% CI, 0.67 to 1.78), respectively. Covariates associated with increased odds of opioid only included HCU, ever smoker, and increasing comorbidity index. PT referral was associated with NSAID/muscle relaxant only, and increasing age and comorbidity index were inversely associated with odds of NSAID/muscle relaxant only. Finally, covariates associated with increased odds of receiving both therapies included high clinic utilizusation, ever smoking, and PT referral. CONCLUSIONS: These data characterize a possible association between low nSES and increased risk of receiving an opioid only when being treated for new back pain. This may be evidence that patients of low nSES are at increased risk of receiving guideline-noncompliant treatment for new back pain.
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Prescription opioid use is lowest in the most deprived neighborhoods in Kaiser Permanente Northern California.
“A large dataset from Kaiser Permanente Northern California showed that prescription opioid use is lowest in the most deprived neighborhoods (52).”
From A Biopsychosocial Overview of the Opioid Crisis: Considering Nutrition and Gastrointestinal Health (2019) · cites this paper as [52]
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Future Directions in Pain Management
Ballantyne, J. C., Sullivan, M. D., & Scherrer, J. F. (2024) · doi:10.1093/9780197675250.003.0010
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Carlin, V. E., Lape, E. C., Deyo, A. G., Ripley, G. H., Polhill, S. E., Zale, E. L., Nam, J. K., Zvolensky, M. J., Maisto, S. A., & Ditre, J. W. (2026) · The American Journal of Drug and Alcohol Abuse · doi:10.1080/00952990.2025.2576709
- Authors
- Gebauer, S., Salas, J., & Scherrer, J. F.
- Affiliations
- Saint Louis University (US)
- Venue
- The Journal of the American Board of Family Medicine
- Published
- 2017-11
- Volume
- 30
- Issue
- 6
- Pages
- 775-783
- ISSN
- 1557-2625 (ISSN-L)
- 1558-7118
- OpenAlex
- W2769094299
- Cited by
- 53
- References
- 36
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 7 · 2023: 5 · 2022: 10 · 2021: 8 · 2020: 10 · 2019: 7 · 2018: 3 · 2017: 1
- FWCI
- 5.41
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of the American Board of Family Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- neighborhood socioeconomic status, back pain, opioid prescribing, nonsteroidal anti-inflammatory drugs, muscle relaxants, primary care, health care disparities, guideline adherence, physiotherapy referral, smoking, comorbidities, regional variation in care, socioeconomic status index, general practice, patient registry data, patient satisfaction
- MeSH terms
- Adult, Aged, Analgesics, Opioid, Back Pain, Female, Humans, Male, Middle Aged, Drug Prescriptions, Primary Health Care, Residence Characteristics, Retrospective Studies, Social Class, Socioeconomic Factors, Treatment Outcome, Practice Guidelines as Topic, Analgesics, Non-Narcotic, Guideline Adherence, Healthcare Disparities
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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