Effects of Including Epidemiologic Data in Lumbar Spine Imaging Reports on Prescribing Non-Opioid Medications for Pain

J Gen Intern Med. 2021 Aug;36(8):2237-2243. doi: 10.1007/s11606-021-06627-6. Epub 2021 Feb 8.


Background: Information on the prevalence of common imaging findings among patients without back pain in spine imaging reports might affect pain medication prescribing for patients with back pain. Prior research on inserting this text suggested a small reduction in opioid prescribing.

Objective: To evaluate the effect of epidemiologic information in spine imaging reports on non-opioid pain medication prescribing for primary care patients with back pain.

Design: Post hoc analysis of the Lumbar Imaging with Reporting of Epidemiology cluster-randomized trial.

Participants: A total of 170,680 patients aged ≥ 18 years from four healthcare systems who received thoracolumbar, lumbar, or lumbosacral spine imaging from 2013 to 2016 and had not received a prescription for non-opioid pain medication in the preceding 120 days.

Intervention: Text of age- and modality-specific epidemiologic benchmarks indicating the prevalence of common findings in people without back pain inserted into thoracolumbar, lumbar, or lumbosacral spine imaging reports at intervention clinics.

Main measures: Primary outcomes: any non-opioid prescription within 90 days after index imaging, overall, and by sub-class (skeletal muscle relaxants, NSAIDs, gabapentinoids, tricyclic antidepressants, benzodiazepines, duloxetine).

Secondary outcomes: count of non-opioid prescriptions within 90 days, overall, and by sub-class.

Key results: The intervention was not associated with the likelihood of patients receiving at least one prescription for new non-opioid pain-related medications, overall (adjusted OR, 1.02; 95% CI, 0.97-1.08) or by sub-class. The intervention was not associated with the number of prescriptions for any non-opioid medication (adjusted incidence rate ratio [IRR], 1.02; 95% CI, 0.99-1.04). However, the intervention was associated with more new prescriptions for NSAIDs (IRR, 1.12) and tricyclic antidepressants (IRR, 1.11).

Conclusions: Inserting epidemiologic text in spine imaging reports had no effect on whether new non-opioid pain-related medications were prescribed but was associated with the number of new prescriptions for certain non-opioid sub-classes.

Trial registration: ClinicalTrials.gov identifier: NCT02015455.

Keywords: analgesics, non-narcotic; health services research; radiology; spine.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Analgesics, Opioid* / therapeutic use
  • Back Pain / diagnostic imaging
  • Back Pain / drug therapy
  • Back Pain / epidemiology
  • Drug Prescriptions
  • Humans
  • Lumbar Vertebrae
  • Practice Patterns, Physicians'*


  • Analgesics, Opioid

Associated data

  • ClinicalTrials.gov/NCT02015455