What proportion of patients with chronic noncancer pain are prescribed an opioid medicine? Systematic review and meta‐regression of observational studies

Abstract

Mathieson S, ). What proportion of patients with chronic noncancer pain are prescribed an opioid medicine? Systematic review and meta-regression of observational studies (Review). J Intern Med 2020; 287: 458-474.Guidelines now discourage opioid analgesics for chronic noncancer pain because the benefits frequently do not outweigh the harms. We aimed to determine the proportion of patients with chronic noncancer pain who are prescribed an opioid, the types prescribed and factors associated with prescribing. Database searches were conducted from inception to 29 October 2018 without language restrictions. We included observational studies of adults with chronic noncancer pain measuring opioid prescribing. Opioids were categorized as weak (e.g. codeine) or strong (e.g. oxycodone). Study quality was assessed using a risk of bias tool designed for observational studies measuring prevalence. Individual study results were pooled using a random-effects model. Meta-regression investigated study-level factors associated with prescribing (e.g. sampling year, geographic region as per World Health Organization). The overall evidence quality was assessed using Grading of Recommendations Assessment, Development and Evaluation criteria. Of the 42 studies (5,059,098 participants) identified, the majority (n = 28) were from the United States of America. Eleven studies were at low risk of bias. The pooled estimate of the proportion of patients with chronic noncancer pain prescribed opioids was 30.7% (95% CI 28.7% to 32.7%, n = 42 studies, moderate-quality evidence). Strong opioids were more frequently prescribed than weak (18.4% (95% CI 16.0-21.0%, n = 15 studies, low-quality evidence), versus 8.5% (95% CI 7.2-9.9%, n = 15 studies, low-quality evidence)). Meta-regression determined that opioid prescribing was associated with year of sampling (more prescribing in recent years) (P = 0.014) and not geographic region (P = 0.056). Opioid prescribing for patients with chronic noncancer pain is common and has increased over time.

Global health policy in the 21st century: Challenges and opportunities to arrest the global disability burden from musculoskeletal health conditions

“…As nation's economies develop, and commercial influence is inadequately regulated, clinicians often implement highly technical but low-value options rather than ensuring that the high-value fundamentals are also accessible [7]. Health systems have also been slow in ceasing support for treatments that are no longer supported by evidence and carry risk of harm, such as lumbar spinal fusion for non-specific back pain and opioid prescribing for chronic non-cancer pain [8,9]. Although clinical guidelines and Models of Care (system-level frameworks that guide service delivery for specific conditions [10]) recommend high-value options as preventive public health strategies and first-line treatments (e.g., exercise and weight loss for osteoarthritis pain), many health systems fail to achieve this.…”

Is opioid therapy for chronic non‐cancer pain associated with a greater risk of all‐cause mortality compared to non‐opioid analgesics? A systematic review of propensity score matched observational studies

“…A systematic review found that the average 1‐month prevalence of moderate‐to‐severe non‐cancer chronic (CNCP) pain was 19% in Europe (Reid et al., 2011). Analgesics such as opioids are frequently used to treat CNCP (Mathieson et al., 2020). There has been an increase in opioid prescriptions in first world countries in the last two decades.…”

Association between clusters of back and joint pain with opioid use in middle-aged community-based women: a prospective cohort study

“…A recent systematic review which included 42 studies (28 from the USA, 9 from European countries, 3 from Canada and 1 each from Australia and India) reported that almost one-third of patients with chronic pain are prescribed opioids [5]. There is significant harm associated with opioid use.…”

“…There are limited effective methods for managing chronic pain [9]. Thus, in developed countries, compassionate advocacy for better treatment of chronic pain influenced the liberalization of laws governing the opioid prescriptions, and along with aggressive marketing of opioid formulations, resulted in relying on opioids for chronic pain relief [5].…”