More Opioids Prescribed for the Same Amount of Pain

Between 2000 and 2010, the rate of opioid prescription increased by 73%, while the portion of patients with a primary symptom or diagnosis of pain was generally stable.

The number of non-cancer patients prescribed opioid painkillers increased dramatically between 2000 and 2010, while the number of patients treated for pain with non-opioid analgesics or with any pharmacologic treatment was generally stable throughout the decade, a new study finds.

The study, published in the October 2013 issue of Medical Care, analyzed data from the 2000-2010 National Ambulatory Medical Care Survey (NAMCS), a nationally representative audit of outpatient office visits, to examine the diagnosis and treatment of nonmalignant pain in ambulatory settings. For the NAMCS, physicians and office staff provided data on a random sample of office visits that occurred during a 1-week period. The researchers then analyzed the data to identify the number of patients with pain as their primary symptom or diagnosis, how many of these patients were treated for their pain, and the portion of patients treated with prescription opioids compared with non-opioid therapies. Cancer patients and those younger than 18 were excluded from the analysis.

Approximately 20.7% of the 7.8 million weighted visit records analyzed from 2000 to 2010 were associated with a primary symptom or diagnosis of pain. Musculoskeletal pain accounted for about half of all pain visits covered by the study. Throughout the decade, pain consistently accounted for about one-fifth of all visits in a given year. In 2000, opioids were prescribed in 11.3% of pain cases, and 60% of pain patients did not receive pharmacologic treatment. In 2010, however, opioids were used to treat 19.6% of pain patients. Despite this 73% increase in the rate of opioid prescription, use of non-opioid painkillers remained relatively consistent throughout the study, ranging from 26% to 29%. During the final year covered by the study, 47% of patients were treated with a pain medication, 20% with an opioid, and 27% with non-opioid therapies.

Approximately half of patients reporting new musculoskeletal pain received pharmacologic treatment. In these patients, opioid prescriptions increased by 62% throughout the decade, rising from 15.1% of visits in 2000 to 24.4% of visits in 2010, while use of non-opioid medications decreased from 38% of visits in 2000 to 29% of visits in 2010.

After adjusting for other factors, the researchers found few patient and provider characteristics associated with prescription opioid use. In a bivariate analysis, rates for opioid prescriptions did not vary based on age, sex, number of comorbid conditions, or whether the patient was new to the practice or physician. In a multivariate analysis, older patients, Hispanics, those on fewer medications, individuals with private insurance, and those who identified their race as neither white nor black were less likely to receive opioids.

The researchers argue that the increase in prescriptions for opioid painkillers may reflect efforts to improve pain recognition and treatment. However, as rates for prescription opioid abuse reach epidemic levels, they suggest that prescribers treat pain with the wide variety of non-opioid pain medications available.

“Policy-makers, professional organizations, and providers should re-evaluate prior efforts to improve the identification, treatment, and management of nonmalignant pain and promote approaches that adequately reflect the importance of non-opioid and non-pharmacologic treatments,” the researchers write.