A 10-yr Analysis of Chronic Pelvic Pain and Chronic Opioid Therapy in the Women Veteran Population

Cichowski, Sara; Rogers, Rebecca G.; Komesu, Yuko M.; Murata, Erin; Qualls, Clifford; Murata, Allison; Murata, Glen H.

doi:10.1093/milmed/usy114

Cited by 26 publications

(11 citation statements)

References 18 publications

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“…Further, in this setting, prior opioid use may be a marker of more severe disease, which is not captured adequately in claims. These risk factors are consistent with predictors of chronic use among patients with other chronic pain conditions, such as chronic pelvic pain 15 and rheumatoid arthritis, 18,27 as well as opioid-naïve surgical patients, [19][20][21] including gynecological surgeries for the treatment of endometriosis. 28 Among women with endometriosis, 60% of chronic opioid users were prescribed benzodiazepines, which is consistent with the coprescribing pattern seen in another commercially-insured population described by Sun and colleagues.…”

Section: Results In Contextsupporting

confidence: 67%

“…Potential risk factors were considered based on existing literature and evaluated in baseline, prior to endometriosis diagnosis. [18][19][20][21] We also quantified the risk of known adverse outcomes associated with opioid use including constipation, dizziness, falls, as well as the risk of dangerous coprescribing with benzodiazepines or other sedatives among chronic users.…”

Section: Methodsmentioning

confidence: 99%

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Chronic opioid use and complication risks in women with endometriosis: A cohort study in US administrative claims

Chiuve

Kilpatrick

Hornstein

et al. 2021

Pharmacoepidemiology and Drug

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Background: Women with endometriosis are prescribed opioids for pain relief but may be vulnerable to chronic opioid use given their comorbidity profile.Methods: A cohort study was conducted in the Clinformatics™ DataMart database between 2006 and 2017 comparing women aged 18-50 years with endometriosis (N = 36 373) to those without (N = 2 172 936) in terms of risk of chronic opioid use, opioid dependence diagnosis, and opioid overdose. Chronic opioid use was defined as ≥120 days' supply dispensed or ≥10 fills of an opioid during any 365-day interval. Among women with endometriosis, we evaluated factors associated with higher risk of chronic opioid use and quantified the risk of complications associated with the use of opioids.Results: Women with endometriosis were at greater risk for chronic opioid use (OR: 3.76; 95%CI: 3.57-3.96), dependence (OR: 2.73, 95%CI: 2.38-3.13) and overdose (OR: 4.34, 95%CI: 3.06-6.15) compared to women without. Chronic users displayed dose escalation and increase in days supplied over time, as well as co-prescribing with benzodiazepines and sedatives. Approximately 34% of chronic users developed constipation, 20% experienced falls, and 8% reported dizziness. Among endometriosis patients, women in younger age groups, those with other comorbidities associated with pain symptoms, as well as those with depression or anxiety were at a higher risk of developing chronic opioid use. Conclusions:Women with endometriosis had a four times greater risk of chronic opioid use compared to women without. Multimorbidity among these patients was associated with the elevated risk of chronic opioid use and should be taken into account during treatment selection.

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Section: Results In Contextsupporting

confidence: 67%

Section: Methodsmentioning

confidence: 99%

Chronic opioid use and complication risks in women with endometriosis: A cohort study in US administrative claims

Chiuve

Kilpatrick

Hornstein

et al. 2021

Pharmacoepidemiology and Drug

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“…One‐quarter of studies did not impose age restrictions (32 studies 23–53 ), while 83 studies included adults only, 11 studies 54–64 focused exclusively on the elderly (aged 65+ years) and two studies 65,66 focused on adolescents and young adults (13‐29 years old). Study populations varied substantially in size, ranging from 121 67 to 48 million people 68 .…”

Section: Resultsmentioning

confidence: 99%

“…One‐fifth of studies included only opioid‐naïve individuals (29 studies), mostly defined as the absence of opioid use in the 6 24,36,37,52,65,69–73 or 12 months 30,48,61,62,74–83 prior to the index date. Some studies investigated opioid use among patients with various specific health conditions: 43 studies 24,26–28,31,37,43,48,49,51,52,59,62,65,70,74,77–80,82–104 focused on noncancer pain, 14 studies 55,56,64,69,105–114 on musculoskeletal conditions, 13 studies 38–40,57,81,115–122 on injuries or trauma and eight studies 23,32,53,67,75,123–125 on infectious diseases. Seven studies 41,44,45,71,126–128 included patients with both cancer and noncancer pain, and six studies evaluated patients with cancer 60,129,130 or cancer survivors 61,131,132 .…”

Section: Resultsmentioning

confidence: 99%

Variations in Long‐term Opioid Therapy Definitions: A Systematic Review of Observational Studies Using Routinely Collected Data (2000‐2019)

Costa

Bruno

Baranwal

et al. 2021

Brit J Clinical Pharma

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Routinely collected data have been increasingly used to assess long‐term opioid therapy (LTOT) patterns, with very little guidance on how to measure LTOT from these data sources. We conducted a systematic review of studies published between January 2000 and July 2019 to catalogue LTOT definitions, the rationale for definitions and LTOT rates in observational research using routinely collected data in nonsurgical settings. We screened 4056 abstracts, 210 full‐text manuscripts and included 128 studies, mostly from the United States (81%) and published between 2015 and 2019 (69%). We identified 78 definitions of LTOT, commonly operationalised as 90 days of use within a year (23%). Studies often used multiple criteria to derive definitions (60%), mostly based on measures of duration, such as supply days/days of use (66%), episode length (21%) or prescription fills within specified time periods (12%). Definitions were based on previous publications (63%), clinical judgment (16%) or empirical data (3%); 10% of studies applied more than one definition. LTOT definition was not provided with enough details for replication in 14 studies and 38 studies did not specify the opioids evaluated. Rates of LTOT within study populations ranged from 0.2% to 57% according to study design and definition used. We observed a substantial rise in the last 5 years in studies evaluating LTOT with large variability in the definitions used and poor reporting of the rationale and implementation of definitions. This variation impacts on research reproducibility, comparability of findings and the development of strategies aiming to curb therapy that is not guideline‐recommended.

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“…Our knowledge of sex- and gender-related differences in the pathogenesis, care delivery and response to treatment is relatively nascent. Pain management represents one field that has generated significant interest in recent years [ 1 – 4 ]. The majority of this research demonstrates that females report more pain and are at increased risk for chronic pain.…”

Section: Introductionmentioning

confidence: 99%

The association of gender and persistent opioid use following an acute pain event: A retrospective population based study of renal colic

et al. 2021

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Introduction This study aims to explore gender-related differences in persistent opioid use following an acute pain episode and evaluate potential explanatory variables. Methods This retrospective population-based study using administrative databases included all opioid-naïve patients in Ontario with renal colic between 2013 and 2017. The primary outcome was to assess any association between persistent opioid use at 3–6 months by gender. Key confounding covariates and explanatory variables examined included both care- and patient-related factors, specifically past evidence of mental health diagnoses. Results The dataset of 64,240 males and 37,656 females demonstrated that 8.7% of males and 9.6% of females had evidence of persistent opioid use 3–6 months after presentation (OR 1.11, 95% CI 1.05, 1.17). Females had a higher incidence of mental health services utilization [44.5% vs 29.6% (p<0.001)] and were more likely to be on a provincial disability program [5.1% vs 3.8% (p<0.001)]. Age, income quintile, mental health diagnoses and dose of opioid prescribed were associated with the primary outcome in both genders. On adjusted analysis for multiple confounding and explanatory variables, females were still more likely than males to demonstrate persistent opioid use (OR 1.07, 95% CI 1.01, 1.13) with even more pronounced associations at 1–2 years. Interpretation After controlling for key covariates, females are at slightly higher risk of demonstrating long term opioid use following an episode of renal colic. Evidence of prior mental health service utilization and acute colic care did not appear to significantly explain these observations.

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A 10-yr Analysis of Chronic Pelvic Pain and Chronic Opioid Therapy in the Women Veteran Population

Abstract: The distinct pattern of prescribing shown in this cohort may mean COT is prescribed for CPP and this prescribing pattern contributes to the adverse events associated with COT. As COT is not recommended for CPP, physicians need more education on the therapies available to help CPP patients.

Cited by 26 publications

References 18 publications

Chronic opioid use and complication risks in women with endometriosis: A cohort study in US administrative claims

Chronic opioid use and complication risks in women with endometriosis: A cohort study in US administrative claims

Variations in Long‐term Opioid Therapy Definitions: A Systematic Review of Observational Studies Using Routinely Collected Data (2000‐2019)

The association of gender and persistent opioid use following an acute pain event: A retrospective population based study of renal colic

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