DETERMINANTS OF NON-PHARMACOLOGIC THERAPY, OPIOID, NON-OPIOID/OPIOID COMBINATION, AND NON-OPIOID MEDICATIONS IN OUTPATIENTS WITH NONMALIGNANT CHRONIC PAIN USING RECENT NATIONAL SURVEY
Author(s)
Zalmai R, Rasu R
University of North Texas Health Science Center, Fort Worth, TX, USA
OBJECTIVES: There have been significant efforts from various organizations to assist clinicians in understanding nonmalignant chronic pain (NMCP) and developing non-medication treatment regimens. The purpose of this study was to assess the medication trends and determinants for non-pharmacologic (physical medicine and rehabilitation, acupuncture, psychotherapy), opioid and opioid/non-opioid combination medications (opioid-based), and non-opioid therapy for NMCP using current national data. METHODS: This was a cross-sectional study using data provided by CDC National Ambulatory Medical Care Survey (NAMCS) from 2006 to 2016 determining recent medication trends. Visits were narrowed down to only include chronic reasons with diagnoses for NMCP, physical medicine and rehabilitation, psychotherapy, or acupuncture. Weighted frequencies of medications (opioid-based, non-opioid) and non-pharmacologic therapy were determined. Patient-specific and external determinants of medication and non-pharmacologic therapy were found using multivariate regression analyses. All analyses were completed using SAS software. RESULTS: Our cohort included 111,201,063 weighted visits representing 60%females and 85%White patients, with mean age 52 years (±15.04). Almost all visits were established(92%) and 40% were with primary care providers (PCP). Visits included opioid(29%, n:32,715,042), opioid combination(25%), non-opioid(38%), and non-pharmacologic therapy(18%). Although, it is not certain from this dataset that all non-opioid medications or non-pharmacologic therapy were for NMCP. Most opioids were prescribed during 2014 and 2015(n:13701318,n:10712160, respectively) and decreased significantly in 2016(n:5769649, 46% from 2015). Patient visits with PCP were 2.3 times[odds ratio(OR):2.28,95%CI:1.97-2.64] more likely to receive an opioid combination and 80% less likely [OR:0.19,95%CI=0.15-0.24] to receive non-pharmacologic therapy compared to non-PCP visits. CONCLUSIONS: Our study provides current trends of medication and non-pharmacologic treatment in NMCP outpatient visits prior to development of new guidelines. As guidelines have been developed since 2016 and as this study shows almost 50% reduction in opioids prescribed in 2016, it is imperative to analyze this data for trends of opioid and non-pharmacologic therapy and its correlation with recent guideline recommendations.
Conference/Value in Health Info
2020-05, ISPOR 2020, Orlando, FL, USA
Value in Health, Volume 23, Issue 5, S1 (May 2020)
Code
PDG49
Topic
Health Service Delivery & Process of Care
Topic Subcategory
Prescribing Behavior, Treatment Patterns and Guidelines
Disease
Drugs, Systemic Disorders/Conditions