According to government survey statistics, the CDC seems to have achieved one of its objectives in its infamous 2016 guideline on opioids for chronic noncancer pain. Still, it was not a drop in accurate opioid prescriptions.
Kevin T. Pritchard, MS, OTR, of the University of Texas Medical Branch in Galveston, and colleagues analyzed Medical Expenditure Panel Survey (MEPS) data from 2011 to 2019. They found that nondrug treatments, including physical therapy and chiropractic services, had significant increases starting in 2017.
According to the study published in JAMA Network Open, the number of patients with chronic pain who used nondrug therapy without opioids remained stable between 2011 and 2016 at 20% but has since increased sharply to 40% in 2019.
For persistent pain, the CDC recommended alternatives to opioids. However, a new version of the guidelines issued last week maintains the previous recommendation to limit opioid use while focusing more on adaptability and individualization.
However, the 2016 recommendations did not result in a significant decrease in the use of opioids for chronic pain, either alone or in combination with nondrug therapies.
From 2016 to 2018, the percentage of patients who relied solely on opioids increased to about 15%, while the rate of patients who relied on opioids in conjunction with nonpharmacologic therapy remained relatively constant at around 3% to 4%.
Pritchard and colleagues did not include the prescription use of NSAIDs, antidepressants, or gabapentinoids.
15-16% of chronic pain patients treated with “nonpharmacologic” treatments also utilized non-opioid medicines, according to MEPS. Patients categorized as receiving neither “nonpharmacologic” nor “opioid” therapy were, on the surface, receiving no treatment at all; yet, as many as one-third of these individuals were taking NSAIDs or other drugs.
“nonpharmacologic treatment” encompasses acupuncture, massage, chiropractic care, and occupational and physical therapy. This analysis left out Cognitive Behavioral Therapy and other forms of psychotherapy.
Chronic pain patients seeking chiropractic therapy grew from 13% in 2018 to 25% in 2019. Over the same period, occupational and physical therapy use almost quadrupled, rising to over 15% by 2019.
Each year, almost 30,000 people take part in MEPS. Pritchard and his team committees all participants who had cancer.
As a result, 15% or more have said they constantly suffer from discomfort. Researchers weighted data from each year so that it would be indicative of the overall adult population outside of institutions.
Pritchard and colleagues sought to explore whether pain alleviation changes people’s lives. 66% of persons with chronic pain say it interferes little or not at all, 15% say it does, 13% say it’s “quite a little,” and 6% say it’s “severe.”
Following controlling for socioeconomic and medical characteristics, experiencing interference predicted no nondrug therapy or opioids after the 2017 CDC recommendation.
This was the case, although experiencing substantial interference was a strong predictor of not receiving either. In 2018-2019, the risk of a person with severe pain not obtaining nondrug therapy or opioids doubled from 2011. The possibility that a person reporting pain interference of “quite a bit” doubled.
The researchers, led by Pritchard, were worried about “barriers to safer alternatives to opioids. “They stated that “accessing frequent outpatient treatments is expensive, difficult with physical limits influencing community mobility,” as well as “complex due to disparities in care access” and “may collide with occupational demands.”
Acupuncture and massage therapies may be used due to “insufficient coverage from private and public payers,” according to the study.
Nonwhites had lower incomes and education levels and were less likely to use opioids with nonpharmacologic treatment, Nahin said.
He added, “Prior experiences, familial features, comorbidities, cultural background, psychological and environmental issues, access to healthcare, and prejudice,”. He said future studies should focus on these elements.
Nahin said practitioners advise using “multimodal, multidisciplinary approaches” (MMAs) to manage chronic pain.
MMAs is an umbrella term that encompasses a wide range of pain management strategies. However, Due to the limitless treatment variations, it’s hard to tell how effectively they work. Whether the patient or the clinician initiates the MMA, the doctor interaction and other therapy factors need to be checked. However, Nahin said it was “a step toward our awareness of how often U.S. people utilize pain management MMAs.”
