PAIN & AGING SECTION Original Research Article Analgesic Use in Older Adults with Back Pain: The BACE Study Wendy T. M. Enthoven, MD,* Jantine Scheele, PhD,* Sita M. A. Bierma-Zeinstra, PhD,* † Herman J. Bueving, MD, PhD,* Arthur M. Bohnen, MD, PhD,* Wilco C. Peul, MD, PhD, ‡ Maurits W. van Tulder, PhD, § Marjolein Y. Berger, MD, PhD, ¶ Bart W. Koes, PhD,* and Pim A. J. Luijsterburg, PhD* Departments of *General Practice and † Orthopaedics, Erasmus University Medical Center, Rotterdam; ‡ Department of Neurosurgery, Leiden University Medical Center, Leiden; § Department of Health Sciences, EMGO Institute for Health and Care Research, Faculty of Earth & Life Sciences, VU University Amsterdam, Amsterdam; ¶ Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands Reprint requests to: Wendy Enthoven, MD, Department of General Practice, Erasmus University Medical Center, PO Box 2040, Rotterdam, 3000 CA, the Netherlands. Tel: +31-10-7032137; Fax: +31-10-7032127; E-mail: w.enthoven@erasmusmc.nl. Disclosure: The authors report no conflicts of interest. Abstract Background. Older patients with back pain are more likely to visit their general practitioner (GP) and are more likely to be prescribed analgesics. Objective. To assess analgesic use in older adults with back pain in general practice. Methods. The BACE study in the Netherlands is a prospective cohort study. Patients (aged >55 years) with back complaints were recruited when consult- ing their GP or shortly thereafter. Measurements took place at baseline and at 3- and 6-month follow- up. For medication use, patients were asked if they had used any medication for their back pain in the previous 3 months and, if so, to specify the medica- tion name, dosage used, frequency of usage, and whether the medication was prescribed or pur- chased over the counter. Results. Of the 1,402 patients who were approached to enter the study, 675 were included. Of these patients, 484 (72%) reported medication use at base- line. Nonsteroidal anti-inflammatory drugs (NSAIDs) (57%) were more often used than paracetamol (49%). Paracetamol was mostly obtained over the counter (69%), and NSAIDs were mostly obtained by prescription (85%). At baseline, patients with severe pain (numerical rating scale score ≥7) used more paracetamol, opioids, and muscle relaxants. Patients with chronic pain (back pain >3 months) used more paracetamol, while patients with a shorter duration of pain used more NSAIDs. During follow-up there was an overall decline in medication use; however, at 3- and 6-month follow-up, 36% and 30% of the patients, respectively, still used analgesics. Conclusions. In these older adults consulting their GP with back pain, 72% used analgesics at baseline. Despite a decrease in medication use during follow- up, at 3 and 6 months a considerable proportion still used analgesics. Key Words. Back Pain; Analgesics; Older Adults Introduction Back pain is a major health problem with a reported lifetime prevalence of up to 84% [1]. In the Netherlands, about 30–45% of patients with back pain visit their general practitioner (GP) [2,3]. A recent study in the UK showed that older patients (>70 years) with low back pain are more likely to visit their GP and more likely to receive analgesics compared with younger adults with back pain [4]. With regard to analgesic options, international guidelines for low back pain usually recommend paracetamol as first Pain Medicine 2014; 15: 1704–1714 Wiley Periodicals, Inc. 1704 Downloaded from https://academic.oup.com/painmedicine/article/15/10/1704/1940593 by guest on 09 July 2022