gms | German Medical Science

Introduction: In the context of a large ongoing collaborative health services research project on pain patients between DAK – Unternehmen Leben (Hamburg), AOK Niedersachsen (Hannover), Grünenthal GmbH (Aachen) and IGES Institut (Berlin), called "Versorgungsatlas Schmerz" ("Health Care Atlas on Pain"), a subproject investigates the use of opioids in back pain patients. Key questions of our study are: How many patients receive opioid prescriptions? What are their characteristics? What is the persistence of opioid therapy?

Methods: Claims data from 2006 and 2007 of about 5,2 Mio beneficiaries of a big German statutory health insurance fund were analysed by means of descriptive statistical methods. Using an innovative diagnosis-based algorithm to identify and classify pain patients in claims data (Freytag et al. 2010) we selected a cohort of beneficiaries of three types of back pain: specific back pain including osteoporosis (n=211.216), pain caused by intervertebral disc disorders (n=195.712) as well as non-specific back pain (n=534.272).

Results: For the treatment of (other) specific back pain, 21% of the beneficiaries received an opioid prescription in 2006, in patients with pain due to spinal disc disease this share accounts for 15% and in non-specific back pain it is only 4%. The share of patients receiving continuous opioid therapy ranges between 24% and 49%. For the the first opioid prescription in 2006 (index prescription) tramadol dominates. It is striking that 14% of the patients with (other) specific back pain received fentanyl – almost twice as much as in the other back pain types. Patients with non-specific bain pain often received codein (resp. codein combinations) (26%). Morphin was prescribed to a strikingly low extent (3–4%). In the cohort of back pain patients with an index prescription of a strong-acting, opioid we observe the following prescription patterns: In a monthly-interval the number of patients receiving opioids monthly drops from 39% after one months to 7% after 6 months. In a 2-month-interval this figure decreases from 69% to 45%. The two different intervals suggest that physicians tend towards prescribing strong-acting opioids in 2-month-intervals rather than in 1-month-intervals. Further results are forthcoming.

Conclusion: International observations show an increase of opioid-use in musculosceletal disorders. But the health care situation with opioids in non-tumor-related pain, such as musculosceletal pain, has not been sufficiently studied. Here we can offer new results for a large back pain population of the third-biggest statutory health care funds in Germany.