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 Great Unknown: Risk-Taking Behavior in Adolescents
19.01.2017 | Max-Planck-Institut für Bildungsforschung

nachricht A sudden drop in outdoor temperature increases the risk of respiratory infections
11.01.2017 | University of Gothenburg

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: Traffic jam in empty space

New success for Konstanz physicists in studying the quantum vacuum

An important step towards a completely new experimental access to quantum physics has been made at University of Konstanz. The team of scientists headed by...

Im Focus: How gut bacteria can make us ill

HZI researchers decipher infection mechanisms of Yersinia and immune responses of the host

Yersiniae cause severe intestinal infections. Studies using Yersinia pseudotuberculosis as a model organism aim to elucidate the infection mechanisms of these...

Im Focus: Interfacial Superconductivity: Magnetic and superconducting order revealed simultaneously

Researchers from the University of Hamburg in Germany, in collaboration with colleagues from the University of Aarhus in Denmark, have synthesized a new superconducting material by growing a few layers of an antiferromagnetic transition-metal chalcogenide on a bismuth-based topological insulator, both being non-superconducting materials.

While superconductivity and magnetism are generally believed to be mutually exclusive, surprisingly, in this new material, superconducting correlations...

Im Focus: Studying fundamental particles in materials

Laser-driving of semimetals allows creating novel quasiparticle states within condensed matter systems and switching between different states on ultrafast time scales

Studying properties of fundamental particles in condensed matter systems is a promising approach to quantum field theory. Quasiparticles offer the opportunity...

Im Focus: Designing Architecture with Solar Building Envelopes

Among the general public, solar thermal energy is currently associated with dark blue, rectangular collectors on building roofs. Technologies are needed for aesthetically high quality architecture which offer the architect more room for manoeuvre when it comes to low- and plus-energy buildings. With the “ArKol” project, researchers at Fraunhofer ISE together with partners are currently developing two façade collectors for solar thermal energy generation, which permit a high degree of design flexibility: a strip collector for opaque façade sections and a solar thermal blind for transparent sections. The current state of the two developments will be presented at the BAU 2017 trade fair.

As part of the “ArKol – development of architecturally highly integrated façade collectors with heat pipes” project, Fraunhofer ISE together with its partners...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Sustainable Water use in Agriculture in Eastern Europe and Central Asia

19.01.2017 | Event News

12V, 48V, high-voltage – trends in E/E automotive architecture

10.01.2017 | Event News

2nd Conference on Non-Textual Information on 10 and 11 May 2017 in Hannover

09.01.2017 | Event News

 
Latest News

Helmholtz International Fellow Award for Sarah Amalia Teichmann

20.01.2017 | Awards Funding

An innovative high-performance material: biofibers made from green lacewing silk

20.01.2017 | Materials Sciences

Ion treatments for cardiac arrhythmia — Non-invasive alternative to catheter-based surgery

20.01.2017 | Life Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>