Opioid use declined in chronic pain patients with no increase in nonpharmacologic therapy

Among adults with chronic pain in 2020, over-the-counter pain relievers and exercise were the most prevalent pain management therapies, and prescription nonopioids were used more than twice as often as prescription opioids, a study found.

To estimate the use of pharmacologic and nonpharmacologic therapies among adults with chronic pain in the United States, researchers used the 2020 National Health Interview Survey (NHIS) (31,568 total respondents) to find adults with self-reported pain on most days or every day in the past three months (n=7,422). Respondents reported the previous three months' use of pharmacologic remedies, defined as prescription opioids, prescription nonopioids, and over-the-counter pain relievers, and nonpharmacologic remedies, including physical or occupational therapy (PT/OT), cognitive behavioral therapy (CBT), exercise, or complementary therapies. The study outcomes were therapy prevalence overall and by demographic characteristics. Results were published Nov. 21 by Annals of Internal Medicine.

Among pharmacologic therapies, use of over-the-counter pain relievers was most prevalent (75.5%), followed by prescription nonopioids (31.3%) and prescription opioids (13.5%). Among nonpharmacologic therapies, exercise was most prevalent (55.0%), followed by complementary therapies (36.7%), PT/OT (17.2%), and CBT (2.6%). Most respondents (60.2%) reported using both pharmacologic and nonpharmacologic therapies; 7.7% reported combined use of opioids, nonopioids, and nonpharmacologic therapy. Pharmacologic therapy use alone was reported by 26.6% of adults, with 22.4% reporting nonopioid use only and 1.0% reporting opioid use only, the authors wrote.

Older patients, those with public insurance, and those who had more severe pain were more likely to use prescription opioids, while younger patients, those with higher household incomes, those residing in the Northeast, and those who were uninsured were less likely to do so. Prescription nonopioids were more likely to be used by patients who were female, were ages 45 to 64 years, were non-Hispanic Black or Hispanic, were on public insurance, or had more severe pain and were less likely to be used by uninsured patients. Patients who were female or non-Hispanic White or who had higher education were more likely to use over-the-counter pain relievers, while those with public insurance were less likely.

Compared with estimates from the 2019 NHIS, prescription opioid use for chronic pain decreased from 15.2% to 13.5% without a corresponding increase in nonpharmacologic therapies, despite guideline recommendations to make the most of their use, the study authors wrote. Limitations of the study include potential recall bias, lack of patient or treatment history, and an inability to identify cancer-related chronic pain or opioid misuse. Also, since the study occurred during the COVID-19 pandemic, limits to health care access and in-person interviews were issues.

“Despite its limitations, this study identifies opportunities to improve guideline-concordant use of pharmacologic and nonpharmacologic therapies among adults with chronic pain,” the authors concluded. “Public health efforts may reduce health inequities by increasing access to pain management therapies so that all persons with chronic pain can receive safe and effective care.”