Prescription opioid use among adults with chronic pain: United States, 2019

Dahlhamer, James M.; Connor, Eric M.; Bose, Jonaki; Lucas, Jacqueline W.; Zelaya, Carla

doi:10.15620/cdc:107641

Cited by 39 publications

(35 citation statements)

References 13 publications

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“…Another survey indicated frequent use of complementary and integrative therapies for chronic pain ( 47 ). Clinicians generally agreed with use of guideline-supported therapies and therapies supported by evidence, including nonpharmacologic therapies; clinicians also felt that treatments should be credible and individualized to the patient ( 48 , 49 ). Clinician concerns regarding nonpharmacologic treatments included costs and safety ( 49 ).…”

Section: Primary Clinical Questionsmentioning

confidence: 99%

“…Surveys indicated high support for use of exercise therapy, complementary medicine therapies, and psychological therapies ( 50 – 52 ); clinicians also supported chronic pain management informed by a biopsychosocial framework or using a multidimensional approach ( 53 ). Barriers to use of therapies included lack of knowledge or expertise and uncertainty regarding potential benefits ( 48 , 50 , 52 – 55 ). Nonopioid Pharmacologic Treatments for Chronic Pain.…”

Section: Primary Clinical Questionsmentioning

confidence: 99%

“…The range of therapeutic options has historically been inaccessible to many patients because of factors such as inadequate clinician education, training, and guidance; unconscious bias; a shortage of pain management specialists; insufficient access to treatment modalities such as behavioral therapy; siloed health systems; insurance coverage and reimbursement policies; and lack of clarity about the evidence supporting different pain treatments ( 6 , 17 , 41 – 46 ). Partly because of these factors affecting access to a wide range of treatment modalities, for many years medications such as prescription opioids have been the mainstay to treat pain, despite very limited evidence to support their long-term (>1 year) benefits; most placebo-controlled trials have been <6 weeks in duration ( 2 , 6 , 47 , 48 ).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

CDC Clinical Practice Guideline for Prescribing Opioids for Pain—United States, 2022

Dowell¹,

Ragan²,

Jones³

et al. 2022

MMWR Recomm. Rep.

790

465

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Summary This guideline provides recommendations for clinicians providing pain care, including those prescribing opioids, for outpatients aged ≥18 years. It updates the CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016 (MMWR Recomm Rep 2016;65[No. RR-1]:1–49) and includes recommendations for managing acute (duration of <1 month), subacute (duration of 1–3 months), and chronic (duration of >3 months) pain. The recommendations do not apply to pain related to sickle cell disease or cancer or to patients receiving palliative or end-of-life care. The guideline addresses the following four areas: 1) determining whether or not to initiate opioids for pain, 2) selecting opioids and determining opioid dosages, 3) deciding duration of initial opioid prescription and conducting follow-up, and 4) assessing risk and addressing potential harms of opioid use. CDC developed the guideline using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Recommendations are based on systematic reviews of the scientific evidence and reflect considerations of benefits and harms, patient and clinician values and preferences, and resource allocation. CDC obtained input from the Board of Scientific Counselors of the National Center for Injury Prevention and Control (a federally chartered advisory committee), the public, and peer reviewers. CDC recommends that persons with pain receive appropriate pain treatment, with careful consideration of the benefits and risks of all treatment options in the context of the patient’s circumstances. Recommendations should not be applied as inflexible standards of care across patient populations. This clinical practice guideline is intended to improve communication between clinicians and patients about the benefits and risks of pain treatments, including opioid therapy; improve the effectiveness and safety of pain treatment; mitigate pain; improve function and quality of life for patients with pain; and reduce risks associated with opioid pain therapy, including opioid use disorder, overdose, and death.

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Section: Primary Clinical Questionsmentioning

confidence: 99%

Section: Primary Clinical Questionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

CDC Clinical Practice Guideline for Prescribing Opioids for Pain—United States, 2022

Dowell¹,

Ragan²,

Jones³

et al. 2022

MMWR Recomm. Rep.

790

465

View full text Add to dashboard Cite

show abstract

“…In 2019, 1 in 5 adults had chronic pain 5 and 22.1% of these had recently used prescription opioids for relief. 6 National guidelines for prescribing opioids for chronic pain 7 and states' opioid regulations have resulted in discontinuation and reduced initiation of opioid prescriptions. 8 Nonopioid medication options are limited for many individuals with pain; for example, nonsteroidal anti-inflammatory drugs (NSAIDs) are contraindicated for many patients experiencing chronic pain, particularly among older patients, who often experience a higher burden of pain.…”

Section: Introductionmentioning

confidence: 99%

“…In 2019, 1 in 5 adults had chronic pain 5 and 22.1% of these had recently used prescription opioids for relief. 6 …”

Section: Introductionmentioning

confidence: 99%

Changes in Prescribed Opioid Dosages Among Patients Receiving Medical Cannabis for Chronic Pain, New York State, 2017-2019

Nguyen

Greene

et al. 2023

JAMA Netw Open

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ImportancePatients with chronic pain often receive long-term opioid therapy (LOT), which places them at risk of opioid use disorder and overdose. This presents the need for alternative or companion treatments; however, few studies on the association of medical cannabis (MC) with reducing opioid dosages exist.ObjectiveTo assess changes in opioid dosages among patients receiving MC for longer duration compared with shorter duration.Design, Setting, and ParticipantsThis cohort study of New York State Prescription Monitoring Program data from 2017 to 2019 included patients receiving MC for chronic pain while also receiving opioid treatment. Of these, patients receiving LOT prior to receiving MC were selected. Individuals were studied for 8 months after starting MC. Data were analyzed from November 2021 to February 2022.ExposuresSelected patients were divided into 2 groups based on the duration of receiving MC: the nonexposure group received MC for 30 days or fewer, and the exposure group received MC for more than 30 days.Main Outcomes and MeasuresThe main outcome was opioid dosage, measured by mean daily morphine milligram equivalent (MME). Analyses were conducted for 3 strata by opioid dosage prior to receiving MC: MME less than 50, MME of 50 to less than 90, and MME of 90 or greater.ResultsA total of 8165 patients were included, with 4041 (median [IQR] age, 57 [47-65] years; 2376 [58.8%] female) in the exposure group and 4124 (median [IQR] age, 54 (44-62) years; 2370 [57.5%] female) in the nonexposure group. Median (IQR) baseline MMEs for the exposure vs nonexposure groups were 30.0 (20.0-40.0) vs 30.0 (20.0-40.0) in the lowest stratum, 60.0 (60.0-70.0) vs 60.0 (60.0-90.0) in the middle stratum, and 150.0 (100.0-216.2) vs 135.0 (100.0-218.0) in the highest stratum. During follow-up, significantly greater reductions in opioid dosage were observed among the exposure group. A dose-response association of patients’ opioid dosage at baseline was observed with the differences in the monthly MME reductions between exposure and nonexposure groups, with a difference of −1.52 (95% CI, −1.67 to −1.37) MME for the lowest stratum, −3.24 (95% CI, −3.61 to −2.87) MME for the middle stratum, and −9.33 (95% CI, −9.89 to −8.77) MME for the highest stratum. The daily MME for the last month of the follow-up period among patients receiving longer MC was reduced by 48% in the lowest stratum, 47% in the middle stratum, and 51% in the highest stratum compared with the baseline dosages. Among individuals in the nonexposure group, daily MME was reduced by only 4% in the lowest stratum, 9% in the middle stratum, and 14% in the highest stratum.Conclusions and RelevanceIn this cohort study of patients receiving LOT, receiving MC for a longer duration was associated with reductions in opioid dosages, which may lower their risk of opioid-related morbidity and mortality.

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Prevalence of Pain Management Techniques Among Adults With Chronic Pain in the United States, 2019

et al. 2022

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with chronic pain were asked to report on their use of 11 pain management techniques during the past 3 months (Table 1), which were coded by the study authors into 6 categories: (1) opioids for chronic pain; (2) opioids for acute pain; (3) physical, occupational, or rehabilitative therapy; (4) psychological and psychotherapeutic therapies (eg, cognitive behavioral therapy); (5) complementary therapies (chiropractic, massage, yoga or tai chi, mediation); or (6) other (selfmanagement, pain peer support group, and other methods for pain management). Participants were not specifically asked about nonopioid pharmacological pain treatments. Survey-weighted prevalence rates for each pain management technique were calculated for selected sociodemographic characteristics. Data were analyzed using Stata version 14.2 (StataCorp) from August to December 2021. Hypothesis testing was 2-sided, and P < .05 was considered statistically significant. ResultsAmong 31 916 participants, 17 261 (64%) were female; 4152 (13%) were Hispanic, 3483 (10.9%) were non-Hispanic African American, and 21 915 (68.5%) were non-Hispanic White; 22 621 (70.9%) were 18 to 64 years of age, with 9295 (29.1%) at least 65 years of age. Pain management techniques used by adults with chronic pain in the US are presented in Table 1. Additionally, we estimated that 54.7% (95% CI, 53.1%-56.3%) of adults with chronic pain only used nonopioid pain management Author affiliations and article information are listed at the end of this article.

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Prescription opioid use among adults with chronic pain: United States, 2019

Abstract: This report presents prevalence estimates of prescription opioid use among U.S. adults with chronic pain.

Cited by 39 publications

References 13 publications

CDC Clinical Practice Guideline for Prescribing Opioids for Pain—United States, 2022

CDC Clinical Practice Guideline for Prescribing Opioids for Pain—United States, 2022

Changes in Prescribed Opioid Dosages Among Patients Receiving Medical Cannabis for Chronic Pain, New York State, 2017-2019

Prevalence of Pain Management Techniques Among Adults With Chronic Pain in the United States, 2019

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