Blog | Tuesday, December 6, 2011

QD: News Every Day--Opioids for abdominal pain doubles in a decade

Opioid prescriptions for chronic abdominal pain visits more than doubled in outpatient clinics between 1997 and 2008, mirroring narcotics use for other noncancer causes of chronic pain, such as musculoskeletal pain and headaches.

Anecdotally, researchers noted that 13% of patients with Crohn's disease at one center and nearly 20% of patients with irritable bowel syndrome in the community reported opioid use, but noted concern if those trends were to hold true on a widespread basis. Opioids for noncancer pain has limited evidence, risks abuse, and may worsen abdominal pain over time.

To assess national use, researchers analyzed National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey data between 1997 and 2008, combining data over four 3-year periods (1997-1999, 2000-2002, 2003-2005, and 2006-2008) to produce national estimates of opioid prescriptions over time. Results appeared in Clinical Gastroenterology and Hepatology.

More than 987,000 outpatient visits representing nearly 10.2 million visits were sampled. Of these, more than 55 million weighted visits were for chronic abdominal pain. The number of outpatient visits for chronic abdominal pain consistently decreased over time from 14.8 million visits or 2,464 visits per 100,000 population from 1997 to 1999 to 12.2 million visits, or 1,863 visits per 100,000 population from 2006 to 2008 (P for trend =.04).

Of the total visits for chronic abdominal pain, 10.1% (95% CI, 8.1% to 12.1%) received at least one opioid prescription. While there were fewer visits over time, the adjusted probability of visits for which an opioid was prescribed consistently increased over time from 5.9% (95% CI, 3.5% to 8.3%) from 1997 to 1999 to 12.2% (95% CI, 7.5% to 17.0%) from 2006 to 2008 (P=.03 for trend).

Opioid prescriptions were most common among patients aged 25 to 40 years old (odds ratio [OR] 4.6; 95% CI, 1.2 to 18.4) and least common among uninsured (OR 0.1; 95% CI, 0.04 to 0.4) and black (OR 0.3; 95% CI, 0.1 to 0.9) patients. Gender, geographic region, urban location and survey setting were not associated with opioid prescribing patterns.

"Opioid use for persistent abdominal pain highlights the growing challenges clinicians face trying to manage chronic illness without the time, infrastructure and incentives needed to take the integrated approach that experts suggest," the study's lead author said in a press release. "Writing a prescription for a pain killer may be the path of least resistance; doing so may satisfy the patient's demand for relief and mitigate the clinician's possible feelings of inadequacy."