Defense Date

11-10-2020

Graduation Date

Fall 12-18-2020

Availability

One-year Embargo

Submission Type

thesis

Degree Name

MS

Department

Pharmacy Administration

School

School of Pharmacy

Committee Chair

Khalid M Kamal

Committee Member

Jordan Covvey

Committee Member

Vincent Giannetti

Committee Member

David Provenzano

Committee Member

Aisha Vadhariya

Keywords

Chronic low back pain, retrospective cohort study, pain clinic, pain procedures, descriptive analyses

Abstract

Background: Chronic low back pain (LBP) is a back pain that lasts for three or more than three months in the lumbar region of the spinal cord. A nerve injury or damage in the spinal cord region (neuropathic pain) requires multimodal treatment approach for pain reduction. With various treatment options utilized in the pain management of these patients, identifying demographical and clinical characteristics of patients with chronic LBP utilizing interventional procedures and pharmacologic treatments is imperative.

Objective: (i) To describe the demographics (age, gender, race, ethnicity, smoking status, alcohol consumption status, drug use status) and clinical characteristics (procedures, medications) of patients with chronic LBP, (ii) to assess the prevalence of comorbid conditions including hypertension, anxiety and depression in the chronic LBP cohort and assess their demographic an clinical characteristics, (iii) to assess the demographic and clinical characteristics of patients with chronic LBP who are currently prescribed the following medications: blood thinners (anticoagulants/antiplatelet), herbal medications, benzodiazepines and opioids, (iv) to assess the mean pain level pre- and post-procedure for patients with chronic LBP that have undergone a single interventional therapeutic LBP procedure throughout the study period.

Methods: A retrospective cohort data analysis was conducted using electronic medical record (EMR) data of newly enrolled patients with chronic LBP in 2018. Data extraction was carried out for LBP patients, but all the analyses were conducted for adult patients with chronic non-cancer LBP. The chronic LBP cohort was identified by filtering out patients who suffered with LBP for less than 3 months (acute) within the study period. Further, patients with any type of cancer as a comorbid condition and those with age below 18 years were excluded from the chronic LBP cohort. Descriptive analyses were conducted to assess demographical and clinical characteristics of chronic LBP patients and cohorts identified within these patients based on the type of comorbidity or medications they were on. Pain relief obtained from interventional therapeutic procedures was also calculated using the mean pain scores before and after the procedure. All statistical analyses were conducted using SAS (SAS Institute Inc., Cary, NC, USA).

Results: A total of 464 adult patients with chronic LBP were identified in the EMR from January 2018 to February 2020. The mean age of the patient cohort was 61.96 years, majority were females (52.8%), Whites (93.97%) and non-Hispanic Latino (96.77%). Most patients never smoked (57.24%) or currently consumed alcohol (53.39%). The mean duration of chronic LBP was 64.15 months and mean office follow-up visits were 3 visits. The most prevalent therapeutic procedure was lumbar epidural steroid injection (ESI) (36.85%) and diagnostic procedure was lumbar medial branch block (15.73%). For patients that underwent lumbar ESI, a maximum of five repetitions and an average of 1.68 repetitions were required to obtain sustained pain relief over a 2-year follow-up period. Also, on an average pain reduction of about 55% was obtained from this procedure. The prevalence of pain medications by line of therapy was found as 24.78% for first-line medications, 26.07% for second-line medications and 9.91% for third-line medications. Patients with chronic LBP also had hypertension (n=188, 40.52%) and anxiety and depression (n=120, 25.86%). Similar patient characteristics were further analyzed based on the type of medications patients were on: (i) blood thinners (n=154, 33.18%), herbal medications (n=45, 9.69%), benzodiazepines (n=67, 14.43%) and opioids (n=121, 26.07%).

Conclusion: Patients with chronic LBP suffer with the condition for a prolonged duration and require multimodal treatment approach including interventional procedures and pharmacologic treatments. Although these treatment options do not provide sustained pain relief, they do provide temporary symptomatic pain relief.

Language

English

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