Trends in the Use of Opioids vs Nonpharmacologic Treatments in Adults With Pain, 2011-2019

Abstract

ImportanceChronic pain prevalence among US adults increased between 2010 and 2019. Yet little is known about trends in the use of prescription opioids and nonpharmacologic alternatives in treating pain.ObjectivesTo compare annual trends in the use of prescription opioids, nonpharmacologic alternatives, both treatments, and neither treatment; compare estimates for the annual use of acupuncture, chiropractic care, massage therapy, occupational therapy, and physical therapy; and estimate the association between calendar year and pain treatment based on the severity of pain interference.Design, Setting, and ParticipantsA serial cross-sectional analysis was conducted using the nationally representative Medical Expenditure Panel Survey to estimate the use of outpatient services by cancer-free adults with chronic or surgical pain between calendar years 2011 and 2019. Data analysis was performed from December 29, 2021, to August 5, 2022.ExposuresCalendar year (2011-2019) was the primary exposure.Main Outcomes and MeasuresThe association between calendar year and mutually exclusive pain treatments (opioid vs nonpharmacologic vs both vs neither treatment) was examined. A secondary outcome was the prevalence of nonpharmacologic treatments (acupuncture, chiropractic care, massage therapy, occupational therapy, and physical therapy). All analyses were stratified by pain type.ResultsAmong the unweighted 46 420 respondents, 9643 (20.4% weighted) received surgery and 36 777 (79.6% weighted) did not. Weighted percentages indicated that 41.7% of the respondents were aged 45 to 64 years and 55.0% were women. There were significant trends in the use of pain treatments after adjusting for demographic factors, socioeconomic status, health conditions, and pain severity. For example, exclusive use of nonpharmacologic treatments increased in 2019 for both cohorts (chronic pain: adjusted odds ratio [aOR], 2.72; 95% CI, 2.30-3.21; surgical pain: aOR, 1.53; 95% CI, 1.13-2.08) compared with 2011. The use of neither treatment decreased in 2019 for both cohorts (chronic pain: aOR, 0.43; 95% CI, 0.37-0.49; surgical pain: aOR, 0.59; 95% CI, 0.46-0.75) compared with 2011. Among nonpharmacologic treatments, chiropractors and physical therapists were the most common licensed healthcare professionals.Conclusions and RelevanceAmong cancer-free adults with pain, the annual prevalence of nonpharmacologic pain treatments increased and the prevalent use of neither opioids nor nonpharmacologic therapy decreased for both chronic and surgical pain cohorts. These findings suggest that, although access to outpatient nonpharmacologic treatments is increasing, more severe pain interference may inhibit this access.

Engagement in Integrative and Nonpharmacologic Pain Management Modalities Among Adults with Chronic Pain: Analysis of the 2019 National Health Interview Survey

“…One recent analysis of the Medical Expenditure Panel Survey (2011–2019) found that female sex and higher levels of education and family income were associated with increased odds of visiting nonpharmacologic providers (eg, acupuncturists and physical therapists) rather than using opioids. 6 Older age, non-White race, Hispanic ethnicity, and having higher levels of pain interference and comorbidities were associated with lower odds of visiting nonpharmacologic providers exclusively. 6 Other studies have found that younger age, female sex, non-Hispanic (NH) White race/ethnicity, and higher levels of education, income, and pain limitations are associated with increased odds of IHM use among subjects with chronic pain, 8 low back or neck pain, 9 , 14 and arthritis.…”

Use of Multimodal Multidisciplinary Pain Management in the US

“…Author affiliations and article information are listed at the end of this article. Therefore, I read with anticipation the study by Pritchard and colleagues, 9 which promised to present nationally representative trends over time in the concomitant use of opioids and NPAs. The authors, using data from the Medical Expenditure Panel Survey (MEPS), were able to identify whether participants used opioids for their pain, NPAs for this pain, both, or no treatment (ie, neither opioids nor NPAs).…”

“…Pritchard and colleagues noted that 5.6% of all participants with pain reported using both opioids and NPA. Although this percentage is less than that seen by Vanneman, et al (15%), Pritchard and colleagues found higher concomitant use of opioids and NPAs in individuals with postsurgical pain (12.7%) vs those with nonsurgical pain (3.7%). Notably, although the postsurgical group saw a substantial increase in concomitant use of opioids and NPAs between 2011 and 2019, this increase was not seen in the nonsurgical group.…”

“…These data are similar to those seen by Vanneman and colleagues and Feldman and Nahin . Pritchard and colleagues noted that 5.6% of all participants with pain reported using both opioids and NPA. Although this percentage is less than that seen by Vanneman, et al (15%), Pritchard and colleagues found higher concomitant use of opioids and NPAs in individuals with postsurgical pain (12.7%) vs those with nonsurgical pain (3.7%).…”

“…The findings of Pritchard et al are a step toward our understanding of the extent to which pain management MMAs are used by US adults. More complete analyses using MEPS and other nationally representative data sets will provide a clearer picture of MMA use and help guide future federal funding initiatives, such as the recent National Institutes of Health HEAL Initiative: Coordinated Approaches to Pain Care in Health Care Systems.…”