November 21, 2023
2 min read
Key takeaways:
- OTC pain relievers were the most used pharmacologic treatment, followed by prescription nonopioids.
- Older adults and those with public insurance were more likely to use prescription opioids.
One in four adults relied solely on medications to manage chronic pain, highlighting an opportunity to increase use of nonpharmacologic therapies, particularly in men, older adults and those with public insurance, according to researchers.
“Findings from this study contribute important information about use of over-the-counter pain relievers, prescriptions nonopioids and exercise, which were found to be some of the most common pain management therapies used by adults with chronic pain,” Stephanie Michaela Rikard, PhD, a health scientist at the CDC, told Healio.
Rikard and colleagues noted that the CDC’s guidelines on opioid treatment for pain recommend a mix of nonpharmacologic and pharmacologic therapies.
“Whereas previous research reported the prevalence of use of nonpharmacologic and opioid therapies for pain, this study adds information about prescription nonopioids, over-the-counter pain relievers, and exercise,” they wrote in Annals of Internal Medicine.
The researchers analyzed 2020 National Health Interview Survey data on 7,422 respondents who reported having pain most days or every day for the past 3 months. They found that 60.2% of adults reported using both pharmacologic and nonpharmacologic therapy. Of those:
- 50.9% reported nonopioid use and use of both pharmacologic and nonpharmacologic therapies;
- 50.9% reported nonopioid use and nonpharmacologic therapy use; and
- 7.7% reported combined use of opioids, nonopioids and nonpharmacologic therapy.
Meanwhile, 26.6% of adults said they used pharmacologic therapy alone, of whom 22.4% reported nonopioid use only and 1% reported opioid use only.
The most common pharmacologic treatments included:
- pain relievers (75.5%);
- prescription nonopioids (31.1%); and
- prescription opioids (13.5%)
The most common nonpharmacologic therapies included:
- exercise (55%);
- complementary therapies (36.7%);
- physical or occupational therapy (17.2%) and
- cognitive behavioral therapy (2.6%).
According to Rikard and colleagues, adults who were older, had more severe pain or had public insurance were more likely to use prescription opioids, whereas younger adults, those uninsured, those who lived in the Northeast and those with higher household incomes were less likely.
Meanwhile, non-Hispanic Black adults, Hispanic adults, those aged 45 to 64 years, those who had more severe pain, those who lived in the South and those who had public insurance were more likely to use prescription nonopioids. In contrast, women, non-Hispanic white adults and those who had a higher education level were less likely to use prescription nonopioids.
The researchers noted there were several limitations to the study. For example, there was potential recall bias, and the COVID-19 pandemic may have impacted the study’s conduct.
“Clinicians should involve patients meaningfully in shared-decision making and provide pain care that is patient-centered and appropriate for the specific condition and patient,” Rikard said. “Health insurers and health systems can contribute to improved pain management and reduce health disparities by increasing access to nonpharmacologic therapies with evidence of effectiveness.”
Perspective
Chronic pain affects a concerningly large number of people, and although we know that a multimodal approach works best to treat chronic pain, not every patient has access to both pharmacologic and nonpharmacologic treatments. This study highlights disparities in treatment based on patient demographics and opportunities for physicians to ensure all patients receive comprehensive treatment. An interesting finding of this study was the notable reduction in opioid prescriptions compared with the previous year, with both physicians and patients potentially responding to the opioid crisis with decreased use of this therapy. This study also brings attention to the low percentage of patients receiving cognitive behavioral therapy. Even though cognitive behavioral therapy can be a highly effective nonpharmacologic treatment option for chronic pain, unfortunately, it can be difficult to access. We continue to have a shortage of mental health professionals to meet the demand. One last thought-provoking finding is the paucity of men treated with nonpharmacologic treatments, which suggests that our health care teams need to focus educational efforts on the efficacy of these treatment strategies in this segment of the population. It is important for patients with chronic pain to develop a long-term, trusting relationship with their treating physician to ensure that they can consider all treatment options.
Jennifer Kendall, DO
Osteopathic physician (physical medicine and rehabilitation)
Board of trustee member, American Osteopathic Association
Disclosures: Kendall reports no relevant financial disclosures.
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