ORIGINAL RESEARCH article
Front. Pain Res.
Sec. Musculoskeletal Pain
PAIN SEVERITY AND OPIOID USE IN PATIENTS WITH SPINE-RELATED DIAGNOSES
Provisionally accepted
- 1The Prescription Drug Misuse Education and Research (PREMIER) Center, College of Pharmacy, University of Houston, Houston, United States
- 2Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, United States
- 3The Prescription Drug Misuse Education and Research (PREMIER) Center, College of Pharmacy, University of Houston, Houston, TX, USA, Houston, United States
- 4The Center for Population Health Outcomes and Pharmacoepidemiology Education and Research (P-HOPER) Center, College of Pharmacy, University of Houston, Houston, United States
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ABSTRACT Objective Clinical guidelines recommend opioid use only in severe and unresponsive cases of low back pain. Limited evidence exists on pain levels and opioid use in spine-related diagnoses (SRD). This study assessed the association between self-reported pain severity and opioid use among U.S. adults with SRD. Methods We conducted a retrospective cross-sectional analysis using 2018–2021 Medical Expenditure Panel Survey (MEPS) data. Adults aged ≥18 with SRD diagnoses and pain prescriptions were included. Pain severity was assessed using the Veterans Rand-12 item on pain interference with routine work. Pain medication use was determined from prescription records. Multivariable logistic regression was used to evaluate the association after controlling for other factors. Results According to the MEPS, there were 1.91 million (95% CI: 1.71-2.11) adults with SRD receiving pain medications annually, among whom 63.92% received opioid prescriptions. Most of the SRD patients were <66 years (69.71%), females (63.14%), and non-Hispanic whites (76.25%). Over half reported high pain interference with their routine activities (52.06%) Multivariable logistic regression analysis revealed that SRD patients who reported high pain interference with their routine work had higher odds of opioid use compared to those who reported low pain interference with their routine work (OR= 2.9222, 95%CI: 1.3649-3.625.70). Conclusion Over half of SRD patients receiving pain medications reported high pain severity levels, and these high pain levels were associated with higher odds of opioid use. While this evidence aligns with the clinical recommendations, more research is needed to understand the opioid use in SRD.
Keywords: Back Pain, MedicalExpenditure Panel Survey, MEPS, Opioids, Pain severity, Spine-related diagnoses, SRD
Received: 11 Sep 2025; Accepted: 15 Dec 2025.
Copyright: © 2025 Okeke, Khalid, Thornton and Aparasu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Rajendar R Aparasu
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