As Opioid Use Soars, No Evidence of Improved Treatment of Pain

A new study led by the Johns Hopkins Bloomberg School of Public Health finds that during a decade when prescription opioid use has skyrocketed, the identification and treatment of pain has failed to improve, and the use of non-opioid analgesics has plateaued, or even declined. The study was published online September 13 in the journal Medical Care.

“There is an epidemic of prescription opioid addiction and abuse in the United States,” notes G. Caleb Alexander, MD, MS, associate professor of Epidemology and Medicine and co-director of the Johns Hopkins Center for Drug Safety and Effectiveness. “We felt it was important to examine whether or not this epidemic has coincided with improved identification and treatment of pain.”

Alexander and his fellow researchers used the National Ambulatory Medical Care Survey, designed by the CDC/National Center for Health Statistics, to analyze trends from 2000 to 2010 associated with patients seeking medical treatment for non-cancer pain. They found no significant change in the proportion of pain visits – approximately one-half – treated with pain relievers.

During this time, non-opioid (analgesic) prescriptions remained stable, consisting of 26-29 percent of pain visits. However, opioid (morphine-related) prescriptions nearly doubled, from 11 percent in 2000 to 19 percent in 2010. Of approximately 164 million pain visits in 2010, roughly half were treated with some kind of pain relieving drug: 20 percent with an opioid and 27 percent with a non-opioid pain reliever.

Alexander and colleagues also examined visits for new-onset musculoskeletal pain and in spite of similar increases in opioid prescribing, the results showed a significant decrease in non-opioid analgesics prescriptions from 38 to 29 percent between 2000 and 2010, despite a lack of evidence showing opioids are more effective or safer than non-opioid treatments for such pain.

Chronic pain affects nearly 100 million U.S. adults and carries major costs in terms of health care and lost productivity. Initiatives designed to increase patient and provider awareness of pain have come with unintended consequences. Prescription opioid abuse has been increasingly documented in emergency department visits and deaths. “By 2008, the annual number of fatal drug poisonings surpassed those of motor vehicle deaths and overdose deaths attributable to prescription drugs exceeded those of cocaine and heroin combined,” Alexander and colleagues write.

The new study is one of the first to focus on trends in pain treatment in ambulatory care—that is, office and clinic visits.

Read the rest of this article here ;http://www.jhsph.edu/news/news-releases/2013/alexander-opiod-pain-use.html