Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Sharp rise in opioid drugs prescribed for non-cancer pain, reports study in Medical Care

16.09.2013
As opioid deaths soar, use of safer alternatives for pain treatment are 'flat or declining'

Prescribing of strong opioid medications for non-cancer pain in the United States has nearly doubled over the past decade, reports a study in the October issue of Medical Care, published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

At the same time, prescribing of non-opioid pain relievers has been stable or declined, according to the new research by Dr G. Caleb Alexander of Johns Hopkins Bloomberg School of Public Health, Baltimore, and colleagues. Dr Alexander comments, "There is an epidemic of prescription opioid addiction and abuse in the United States, and we felt it was important to examine whether or not this epidemic has coincided with improved identification and treatment of pain."

Opioid Prescribing for Non-Cancer Pain Increases

Using a nationally representative database of U.S. doctors' office visits, the researchers analyzed trends in visits for pain and medications prescribed for pain from 2000 to 2010. The study focused on trends in the use of strong opioid (morphine-related) pain medications for non-cancer pain. The study was performed in affiliation with the Johns Hopkins Center for Drug Safety and Effectiveness, for which Dr Alexander serves as Co-Director.

The results showed no significant change in the proportion of doctor's office visits with pain. Throughout the decade, pain was consistently reported by patients or diagnosed by doctors at about one-fifth of visits. There was no change in the proportion of pain visits treated with pain relievers (analgesics).

However, there was a significant increase in prescriptions for opioid medications. The rate of opioid prescribing for pain visits increased from 11.3 percent in 2000 to 19.6 percent in 2010.

At the same time, prescribing of non-opioid pain-relieving drugs remained stable: between 26 and 29 percent throughout the decade. Out of approximately 164 million pain visits in 2010, about half were treated with some kind of pain-relieving drug: 20 percent with an opioid and 27 percent with a non-opioid pain reliever.

Analysis of visits for new-onset musculokeletal pain found a similar increase in opioid prescribing but a significant decrease in prescribing of non-opioid analgesics: from 38 to 29 percent. The percentage of patients receiving both opioid and non-opioid pain relievers also increased during the period studied.

Need for Increased Attention to Safer Alternatives for Pain Treatment

After adjustment for other factors, there were few patient, physician, or practice characteristics related to higher or lower rates of opioid use for non-cancer pain. Rather, "increases in opioid prescribing generally occurred non-selectively over time," Dr Alexander and coauthors write.

Chronic pain affects approximately 100 million U.S. adults, and carries major costs in terms of health care and lost productivity. A growing awareness of the high prevalence and impact of pain has prompted efforts to improve its identification and management—for example, by routinely assessing pain as the "fifth vital sign."

An unintended consequence of those efforts has been a well-documented increase in opioid use and abuse in the United States, with consistent increases in emergency department and deaths from prescription opioid abuse. "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," Dr 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.

The results highlight the importance of balancing the risks and benefits of analgesics prescribed in the primary care setting. "The majority of pain medications are prescribed by primary care physicians, who treat over half of the chronic pain patients in the United States" comments Matthew Daubresse, MHS, lead author of the new report. "Pain specialists only treat a fraction of these patients."

"We found that not only have the rates of treated pain not improved, but in many cases, use of safer alternatives to opioids, such as medicines like ibuprofen and acetaminophen, have either stayed flat or declined," says Dr Alexander. "This suggests that efforts to improve the identification and treatment of pain may have backfired, due to an over-reliance on prescription opioids that have caused incredible morbidity and mortality among patients young and old alike."

The researchers note that non-opioid prescribing decreased despite a lack of evidence showing that opioids are more effective or safer for the treatment of non-cancer pain. Dr Alexander and colleagues conclude, "Policy-makers, professional organizations, and providers should re-evaluate prior efforts to improve the identification, treatment and management of nonmalignant pain and promote approaches that adequately reflect the importance of nonopioid and non-pharmacologic treatments."

About Medical Care

Rated as one of the top ten journals in health care administration, Medical Care is devoted to all aspects of the administration and delivery of health care. This scholarly journal publishes original, peer-reviewed papers documenting the most current developments in the rapidly changing field of health care. Medical Care provides timely reports on the findings of original investigations into issues related to the research, planning, organization, financing, provision, and evaluation of health services. In addition, numerous special supplementary issues that focus on specialized topics are produced with each volume. Medical Care is the official journal of the Medical Care Section of the American Public Health Association

About Wolters Kluwer Health

Wolters Kluwer Health is a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Serving more than 150 countries and territories worldwide, Wolters Kluwer Health's customers include professionals, institutions and students in medicine, nursing, allied health and pharmacy. Major brands include Health Language®, Lexicomp®, Lippincott Williams & Wilkins, Medicom®, Medknow, Pharmacy OneSource®, ProVation® Medical and UpToDate®.

Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company. Wolters Kluwer had 2012 annual revenues of €3.6 billion ($4.6 billion), employs approximately 19,000 people worldwide, and maintains operations in over 40 countries across Europe, North America, Asia Pacific, and Latin America. Follow our official Twitter handle: @WKHealth.

Connie Hughes | EurekAlert!
Further information:
http://www.wolterskluwer.com

More articles from Studies and Analyses:

nachricht The personality factor: How to foster the sharing of research data
06.09.2017 | ZBW – Leibniz-Informationszentrum Wirtschaft

nachricht Europe’s Demographic Future. Where the Regions Are Heading after a Decade of Crises
10.08.2017 | Berlin-Institut für Bevölkerung und Entwicklung

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: The pyrenoid is a carbon-fixing liquid droplet

Plants and algae use the enzyme Rubisco to fix carbon dioxide, removing it from the atmosphere and converting it into biomass. Algae have figured out a way to increase the efficiency of carbon fixation. They gather most of their Rubisco into a ball-shaped microcompartment called the pyrenoid, which they flood with a high local concentration of carbon dioxide. A team of scientists at Princeton University, the Carnegie Institution for Science, Stanford University and the Max Plank Institute of Biochemistry have unravelled the mysteries of how the pyrenoid is assembled. These insights can help to engineer crops that remove more carbon dioxide from the atmosphere while producing more food.

A warming planet

Im Focus: Highly precise wiring in the Cerebral Cortex

Our brains house extremely complex neuronal circuits, whose detailed structures are still largely unknown. This is especially true for the so-called cerebral cortex of mammals, where among other things vision, thoughts or spatial orientation are being computed. Here the rules by which nerve cells are connected to each other are only partly understood. A team of scientists around Moritz Helmstaedter at the Frankfiurt Max Planck Institute for Brain Research and Helene Schmidt (Humboldt University in Berlin) have now discovered a surprisingly precise nerve cell connectivity pattern in the part of the cerebral cortex that is responsible for orienting the individual animal or human in space.

The researchers report online in Nature (Schmidt et al., 2017. Axonal synapse sorting in medial entorhinal cortex, DOI: 10.1038/nature24005) that synapses in...

Im Focus: Tiny lasers from a gallery of whispers

New technique promises tunable laser devices

Whispering gallery mode (WGM) resonators are used to make tiny micro-lasers, sensors, switches, routers and other devices. These tiny structures rely on a...

Im Focus: Ultrafast snapshots of relaxing electrons in solids

Using ultrafast flashes of laser and x-ray radiation, scientists at the Max Planck Institute of Quantum Optics (Garching, Germany) took snapshots of the briefest electron motion inside a solid material to date. The electron motion lasted only 750 billionths of the billionth of a second before it fainted, setting a new record of human capability to capture ultrafast processes inside solids!

When x-rays shine onto solid materials or large molecules, an electron is pushed away from its original place near the nucleus of the atom, leaving a hole...

Im Focus: Quantum Sensors Decipher Magnetic Ordering in a New Semiconducting Material

For the first time, physicists have successfully imaged spiral magnetic ordering in a multiferroic material. These materials are considered highly promising candidates for future data storage media. The researchers were able to prove their findings using unique quantum sensors that were developed at Basel University and that can analyze electromagnetic fields on the nanometer scale. The results – obtained by scientists from the University of Basel’s Department of Physics, the Swiss Nanoscience Institute, the University of Montpellier and several laboratories from University Paris-Saclay – were recently published in the journal Nature.

Multiferroics are materials that simultaneously react to electric and magnetic fields. These two properties are rarely found together, and their combined...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

“Lasers in Composites Symposium” in Aachen – from Science to Application

19.09.2017 | Event News

I-ESA 2018 – Call for Papers

12.09.2017 | Event News

EMBO at Basel Life, a new conference on current and emerging life science research

06.09.2017 | Event News

 
Latest News

Rainbow colors reveal cell history: Uncovering β-cell heterogeneity

22.09.2017 | Life Sciences

Penn first in world to treat patient with new radiation technology

22.09.2017 | Medical Engineering

Calculating quietness

22.09.2017 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>