Korean J Pain.  2024 Jan;37(1):73--83. 10.3344/kjp.23246.

Trends in the prescription of opioids and gabapentinoids in patients with failed back surgery syndrome in Korea: a population-based study

• Oh J
• Yeo J

• KMID: 2550134
• DOI: http://doi.org/10.3344/kjp.23246

Abstract

Background
Failed back surgery syndrome (FBSS) is a chronic condition that is characterized by persistent back pain following one or more spinal surgeries. Pharmacological interventions, such as the use of opioids and gabapentinoids, are frequently used in the treatment of FBSS. However, prolonged and excessive use of these medications can lead to dependence and adverse effects. This study investigates trends in opioid and gabapentinoid prescriptions among patients with FBSS in Korea from 2016 to 2020.
Methods
Data from the Health Insurance and Review Agency were analyzed, and claims listing FBSS were selected for the study. Prescription patterns of opioids and gabapentinoids were classified based on the number of days prescribed per year.
Results
Of the 390,095 patients diagnosed with FBSS, 41.6% of the patients were prescribed gabapentinoids, and 42.0% of them were prescribed opioids, while 10.6% of the patients were classified as long-term gabapentinoid users, 11.4% as long-term opioid users, and 7.4% of the patients were found to have long-term prescriptions for both drugs. The proportion of patients who received both gabapentinoid and opioid prescriptions increased annually. The doses of opioids prescribed have also increased along with the increase in the number of patients receiving opioid prescriptions.
Conclusions
The prescription rates of opioids and gabapentinoids among patients with FBSS in Korea continue to increase steadily, posing potential risks of addiction and adverse effects. Further research is needed to better understand the actual status of addiction in patients with FBSS.

Keyword

Analgesics; Opioid; Big Data; Drug-Related Side Effects and Adverse Reactions; Failed Back Surgery Syndrome; Gabapentin; Insurance; Health; National Health Programs; Pregabalin; Prescriptions

Figure

• 

  Fig. 1 Yearly trends of patients prescribed gabapenditoids. (A) The number of patients who have never been prescribed gabapentionid (naïve) or who have been prescribed it at least once (prescribed). (B) Percentage of patients by the degree of gabapentinoid prescription duration. Naïve: not prescribed gabapentinoids in the year. Prescribed: prescribed the gabapentinoids at least once in the year. Episodic: days for gabapentinoid prescription is more than a day and less than 120 days in the year. Long-term: days for gabapentinoid prescription is 120 days or more in the year.

• 

  Fig. 2 Yearly trends of patients prescribed opioids. (A) The number of patients who have never been prescribed opioids (naïve) or who have been prescribed it at least once (prescribed). (B) Percentage of patients by the degree of opioids prescription duration. Naïve: not prescribed opioids in the year. Prescribed: prescribed the opioids at least once in the year. Episodic: days for opioid prescription is more than a day and less than 120 days in the year. Long-term: days for opioid prescription is 120 days or more in the year.

• 

  Fig. 3 Yearly trends in opioids prescription patterns. (A) Proportion of weak only and strong in the patients episodic (less than 120 days in the year) prescribed opioids. (B) Proportion of weak only and strong in the patients long-term (120 days or more in the year) prescribed opioids. Weak: prescribed only weak opioids, Strong: prescribed strong opioids with or without weak opioids. Weak opioids include tramadol, codeine, dihydrocodeine, and hydrocodone. Strong opioids include fentanyl, morphine, oxycodone, hydromorphone, and tapentadol.

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  Fig. 4 Yearly trends in morphine equivalent doses (MED) of prescribed opioids. (A) Total MED of prescribed opioids and MED per opioid-prescribed patients in the year. MED per opioid-prescribed patients was calculated by dividing the total MED of narcotic analgesics prescribed in the year by the number of patients prescribed opioids. (B) The proportion of the total MED prescribed in the year accounted for by the MED of weak opioids and strong opioids.

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