Blog | Tuesday, September 24, 2013

QD: News Every Day--Pain diagnoses double in past decade, as does opioid prescribing


Patients’ complaints of pain have not changed in the past 10 years, while providers’ diagnoses of pain as a primary complaint nearly doubled, a study found. And while opioid prescribing nearly doubled, nonopioid alternative prescriptions have not.

Researchers applied outpatient data from the 2000–2010 National Ambulatory Medical Care Survey to examine the diagnosis and management of nonmalignant pain in office-based settings. Results appeared in the October issue of Medical Care.

Primary symptoms or diagnoses of pain varied little from 2000 to 2010, remaining about one-fifth (20.7%) of visits. While patient-reported pain as the primary symptom was consistent, provider-reported pain increased nearly 50% from 2000 (5.7% of visits with pain as a primary diagnosis; 95% CI, 4.96% to 6.49%) to 2010 (8.5%; 95% CI, 7.53% to 9.42%). Musculoskeletal pain was about half of all nonmalignant pain visits from 2000 to 2010.

From 2000 to 2010, although rates of opioid use increased 73% from 11.3% of visits (2000) to 19.6% of visits (2010), prescribing rates of nonopioid pharmacotherapies remained relatively constant (26% to 29%). By 2010, of 164 million pain visits, about one-half (47%; 95% CI, 43.24% to 50.06%) were treated with a pain medicine, one-fifth with an opioid (20%; 95% CI, 17.17% to 22.06%), and one quarter (27%; 24.59% to 29.49%) with a nonopioid drug such as NSAIDs, acetaminophen or adjuvant therapy.

Using opioids with nonopioids increased as well. Taking opioids with NSAIDs increased 39%, from 3.7% of visits in 2000 to 5.2% of visits by 2010. Taking opioids with acetaminophen increased from 0.5% to 0.6% of visits and opioids with adjunctive therapies increased from 2.9% to 7.1% of visits.

Opioid prescribing increased 62% from the year 2000 (15.1% of visits; 95% CI, 11.77% to 18.39%) to the year 2010 (24.4%; 95% CI, 20.80% to 28.04%). Nonopioid prescribing for musculoskeletal pain decreased from 38% (95% CI, 34.09% to 41.06%) of visits in 2000 to 29% (95% CI, 25.55% to 32.48%) of visits in 2010. These declines were primarily driven by reductions in NSAIDs.

G. Caleb Alexander, MD, FACP, corresponding author, and co-authors wrote that the increased provider diagnoses of pain may reflect awareness campaigns such as the “Pain as the fifth vital sign” initiative and the World Health Organization pain ladder, or increased pharmaceutical marketing of new drug therapies. “Nevertheless, there is still considerable discordance between patient and provider reports of pain, which may be due to a variety of factors, such as clinicians’ tendency to diagnose underlying causes of pain rather than pain itself, and is worthy of further investigation.”