Understanding healthcare services and medication use among patients with low back pain

Abstract

Low back pain has high prevalence worldwide and is one of the most common reasons for care seeking. Clinical practice guidelines provide clear recommendations for the management of low back pain. The aims of this thesis are to evaluate equity of low back pain research and care delivery in minority populations and to investigate the use of opioid therapy for low back pain in the emergency department. The meta-epidemiological study presented in Chapter Two included randomised controlled trials evaluating at least one type of physiotherapy intervention for the treatment or prevention of low back pain and extracted data on language-grounded eligibility criterion and the number of consequent exclusions. The systematic review presented in Chapter Three included observational studies which compared the use of lumbar imaging, opioid analgesics, and spinal surgery for the management of non-serious low back pain between people from different racial and ethnic populations. The cross-sectional study presented in Chapter Four analysed data extracted from electronic medical records of 14,642 adult patients diagnosed with non-serious low back pain at three emergency departments in Australia from January 2016 to October 2021. The systematic review presented in Chapter Five included 72 randomised controlled trials and observational studies which investigated opioid therapy, i.e., opioid administration in the emergency department and/or an opioid prescription at discharge, in adult patients with musculoskeletal pain. The cross-sectional study presented in Chapter Six examined the amount of opioids administered to patients with low back pain in three public hospitals in Australia and determined factors associated with high daily dosage. The study presented in Chapter Seven linked and analysed primary care registry data and data of participants who reported chronic neck and/or low back pain in the fourth wave of the Nord-Trøndelag Health Study conducted in Norway.