Opioids Still Being Prescribed for Newly Diagnosed Musculoskeletal Pain

Opioids Still Being Prescribed for Newly Diagnosed Musculoskeletal Pain

A study out of the National Institutes of Health (NIH) study shows during their visit to a physician, patients experiencing newly diagnosed chronic musculoskeletal pain are prescribed opioids more often than physical therapy, counseling, and other nonpharmacologic approaches.

The study was published in the Journal of Pain. according to a new study published in the Journal of Pain.

The use of opioids over other approaches stands in contrast with clinical recommendations for the use of nonopioid pain approaches and nonpharmacologic approaches. The study included authors from the National Center for Complementary and Integrative Health (NCCIH), part of the National Institutes of Health; the University of Montreal; and McMaster University in Hamilton, Ontario, Canada.

“Particularly when the patient is experiencing pain that may become chronic, that first clinical encounter can set the course for patient care moving forward,” said Helene Langevin, M.D., director of NCCIH. “This study was designed to assess the ways in which real-world practice compares and contrasts with practice guidelines for these initial patient encounters.”

Study authors analyzed data from the National Ambulatory Medical Care Survey (NAMCS), conducted between 2007 and 2015. The survey data are collected by the Centers for Disease Control and Prevention’s National Center for Health Statistics and represent how medical care services are used in the United States. The results concur with the high prevalence of chronic musculoskeletal pain in the United States, with an average of 36.8 million initial visits (for a new chronic pain problem) per year or approximately 11.8% of the population.

Patients were prescribed nonopioid medication 40.2% of the time, opioids 21.5%, counseling 15.2%, other nonpharmacologic treatments 14.3%, and physical therapy (PT) least often, at 10%. The most common nonopioid medication prescribed was nonsteroidal anti-inflammatory drugs (NSAIDs), prescribed at 31.1% of initial visits. Nonpharmacologic treatments included counseling, prescribed at 15.2% of initial visits, exercise at 11.7%, diet and nutrition at 6.4%, complementary approaches at 6%, and weight reduction at 3%.

The study also found that provider specialty was associated with treatment approaches.

  • Internists, orthopedists, and neurologists were less likely than family practitioners to prescribe opioids.
  • Oncologists, general surgeons, and orthopedists were also less likely to prescribe other types of medication compared to family physicians.
  • Orthopedists and neurologists referred patients to PT more than family doctors did.
  • General surgeons were less likely to prescribe other nonpharmacologic treatments.
  • Compared to physicians with an M.D. degree, those with a D.O. degree were more likely to prescribe nonpharmacologic treatment other than PT or counseling.

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Authored by: Ed Coghlan

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Mr. Gottlieb

People get addicted at parties, clubs and on the street. Doctors no longer give us any medication to even kill our pain. This is ridiculous. I know the entire “opoid crisis “from start to finish. I know about every move that was made to create that convenient crisis. From the pill mills to Afghanistan to the streets. But all I’m going to say right here is repeat what I said at the beginning. Because it’s true People only get addicted at clubs parties and the street. Period.

Jana

um….er….alternate universe much?

Granny

Ludicrous. Data is not current.

All this willll do is make the bad situation worse…but trying to imply that GPs or PCPs are at fault for starting yhe chain of events believed to lead to addiction. Ludicrous.

How about articles on the number of deaths of un/under-medicated chronic pain patients who die by alcohol or illicit street drugs?? People in such horriffic pain and despair that they will take anything, ANYTHING, for at least a little relief?? Or the chance of some relief??

Time to address the imported and home-grown lethal street drugs and readily available alcohol.

Time to focus on the REAL issues and give CPPs some dignity and relief, with MEDs that are readily available.

Ludicrous!!

Kathy

Fascists! I thought this was a free country! So what? Doctors prescribe Opioids for pain. The government sticks its nose into too many things. People who have real pain are denied relief because of idiots who abuse Opioids. There has to be a better way .

Dooney

I say BS. I just scanned the article but dont believe any study that states patients are getting opioids as first option from any physician. My husband lost his family doctor and now goes to a low cost clinic because of no insurance and they absolutely refuse to prescribe any opioids. The practice I go to your doctor brings your case to a review board at the practice. I can’t even get a 2 day supply of Valium for intense muscular pain. My husband has back pain and he takes Motrin. Any doctor in my town you have to fill out an application. They only want to take the healthy patients with good insurance ! My stepdaughter worked at an office where if you took pain meds or psych meds your app went in the trash.

Ann Sable

Sorry to say, but this is complete farce. Excellent questions and comments here, though. That, I can agree with wholeheartedly. Marijuana, in any form, no thank you! Alcohol, nope again. Their logic is that if something works, take it away. I use to be on Soma years ago, no high, but was able to carry out my day without rolling into a ball and dropping to the floor. Did it work? Of course it did so let’s abruptly stop that. Pain meds took the tip off pain off. Did it work? Of course it did so let’s abruptly stop that, too. Can no longer go to PT. I keep getting referrals to go, they look at my images and charts and then discharge me automatically. Always being told that they cannot do any PT until I have corrective surgery and the Dr’s turn all of that down every time. I’m fighting just to keep my diazepam, which is the only treatment I am receiving now. It keeps my intestines under control (since 2 ft of bowel was taken along with abdominal nerves cut…that failed) and it helps keep me from going into one huge body spasm that curls you up and unable to move. My cervical and lumbar is completely deteriorated and spine is at its breaking point. I could keep going on with what I’m dealing with, but it’s of no use any longer. The alphabet gang needs to listen to the voices that are crying out and to fix what they did to the rest of the world at our expense…DECEPTION. To all of us CPPS, sincerest love, respect and unity.
Blessings-

Some further thoughts,
1. If cpp have nowhere to turn for help, Where will they turn for help?
2. They Studies have done absolutely to prove anything. Why are they still being done? Why weren’t studies get started when the FDA / CDC / DEA became part of the government agencies? Opiates go back since man’s been able to draw pictures on a cave wall.
3. Deaths overdose from illegal drugs is still happening. Why still do the chronic pain patients have to pay for other people’s irresponsible choices?
4. If talking about chronic pain patients using opiates is an uncomfortable conversation to gov agencies. Then why isn’t death by lethal injection? Or prison sentences for murderers, rape, child molestation? Why is it so hard to talk about relieving the suffering law-abiding citizens pain??
5. When Death from alcohol is read in newspapers daily killing the innocent /uninnocent. Why does the gov allow it on shelves & allow buying it uncontrolled? Alcohol is the number one item teens try first because it’s easily available.
6. Gov wants people to use marijuana / DEA doesn’t but the CDC let several people died due to Vapor inhaling that was mostly tied to marijuana not flavored candy vapor like they want you to think. How did these teens get vapored marijuana when they’re not supposed to have it?
7. The new move is for people in chronic pain to do CBD oil, acupuncture , acupressure, massage therapy, physical therapy, mental health therapy. All of this stuff has been done before & it still doesn’t work.
NSAIDs work for some people but they better check their liver. NSAIDs people can’t take. When will the screwing over of people that are in chronic pain ever get their life back to where we can function?
8. Those that decide to commit suicide please send letter 1 to the newspaper telling the reasons why naming those people 2 make sure your family has one 3 make several copies to mailout to your friends & be sure to send one to pain Warrior

W L

My health issues are kept in control with opiods in moderate amounts. A new specialist recently prescribed gabapentin – A DAMN NIGHTMARE! I will be discarding this medication – there is volumes of scientific research as well as studies that indicate many have adverse effects – including myself. The negative effects are worse than taking nothing at all – and I WILL BE FILING AN ADVERSE COMPLAINT with FDA. There is also a possible “Class Action” that can be found at lawyersandsettlements.comThat physicians think they can change things and a patient’s health issues will decrease is unbelievable. They NEED TO LISTEN TO THE PATIENT – not Big Pharm. Guess I will be heading back (over 800 miles) to my previous physician who had no problem in refilling “what has worked for me for years”. Thanks to the new specialist I am worse off than I was – so I wonder if they will assume the financial costs when I have issues with further decreased mobility. SHAME ON THEM! I would also urge everyone to go to “Dollars for Docs” to see if their medical provider is getting any money from Big Pharma reps.
We are not guinea pigs for medical providers – they should not be prescribing something on a trial & error basis when the patient knows what works for them. Angry – you bet especially when I have co-pays for the provider and prescription. I should have them reimburse me for their poor advice.

Jennifer Turner

I’m not allowed to take NSAIDS and opioids should be COMBINED with other therapies. They’re called pain medications for a reason. You can do physical therapy and try everything in the book and sometimes nothing helps. I’m not an addict, I’m a pain patient and I have horrible pain that I wouldn’t be able to tolerate if I didn’t have my pain medication which happens to be an opiate.I don’t overuse and I’m not prescribed too much for the type of pain that I have which is horrendous and I wouldn’t be able to live a life without the pain medication. This study was really a waste of time and probably a waste of someone’s money that can’t afford it.

Judy Dunn

Pain meds are still prescribed by Pain Management but not enough to actually
Help lessen the amount of pain most chronic pain patients have to deal with on a
Daily basis. They all manage to take their survey’s but I still haven’t seen any on
The number of chronic pain patients that have committed suicide because they
Could no longer take the pain they are in without being giving the pain medication
That they needed so desperately. The medication that they took for years without
any problems, the medication that allowed them to live a normal life. The medication that dulled their pain enough for them to perform their daily chores.

Where is our Survey? How many chronic pain patients lost their Doctors, Doctors
Who feared being arrested for actually treating their patients. How many chronic
Pain patients have been abused by the Media, abused by the Pharmcy’s staff
and treated like a drug addict?

Our World was hard enough before your fake opioid crisis, blaming us made it
Much harder.

maxlet

wtf??? while millions of long-term, structurally mangled people with great long-term success on opioids are losing their meds & being forced into non-functionality or suicide, they’re trying to tell me that docs are flinging out opioids for new musculoskeletal pain?? B frigging S.

PLEASE, tell me who those docs are: I’m going to them to get my dose of opiates restored –the one I had a life on for decades.

Amanda P.

I have been off opioids for 3 years. I have done absolutely everything my doctors have asked me to try. Absolutely nothing has worked. They are still just prescribing the nsaids even though i am bleeding from my bowels. The pain is all consuming with no relief in sight. The only thing that worked for me was tramadol. And no doctor will prescribe that. Noone! Cancer patients going without pain meds due to the guidelines and the DEA. I am turning 40 soon. I am also taking care of my disabked husband who has intractable pain from work injury. So i must carry on somehow. So tired and worn down by the government dictating what i can and cannot have. Feels like a communist country with all these new regulations and laws. Just. So. Tired.

Phyllis

I’m in so much pain, that I apologize for how I made fun of those who bought illegal drugs. I’m now seeing my fellow patients kill themselves & wish theyd have bought off the st, so they’d still be alive. Sometimes I have got so much pain my eyes just cry. I pray for death most of the time. I’m not living just existing. I was on a FENTANYL PATCH & METHADONE & I couldve gone to the store, clean my place, cook, see other humans(priceless) & laugh yet now Drs look at me like Im a drug attack yet they have seen my MRIs. Need back surgery, yet they wont do that either. When Im not on pain meds, my heart can’t handle pain so it attacks, I guess. When I’m in bad pain, my blood pressure is the highest any dr has seen.I don’t know why I can’t kill myself like others do! Maybe I’ll just stroke out from pain. Know someone with colon cancer that gets 3 NORCO a day. Pain doesnt help u fight that cancer away. China has got so many painkillers on the sts of America. Pain isn’t going away so u’ve got 2 choices now. China made or kill urself. I’ve tried EVERYTHING, spinel stenosis, makes me crawl now

JERRY ESTERS

Most of us that have been down these roads know all about nsids and waste time on many of the useless remedys that dont work 🙁 Of course i will agree to try anything as the hope that a miracle may happen ! Gabapentin does help and it helped some the last time i had severe break through pain in my neck and shoulder and arm which is a new development other than the constant lumbar and legg pain . After a ER visit twice pleading for help and doubling down on the gabapentin with more shots on the neck it started to reverse however i increased the percocet from 4 a day to 6 with 3 in the am and 3 in the pm robbing my monthly supply 🙁 I discovered that being totally transparent and bringing my records to the er room made no differance witht he DR WHO COULD HAVE TENDERED a shot of morephine right then and stopped the unbearable torture! THe pain is managable now after a week and i have to go with out my regular dose to make up for those days i couldnt stand it and prayed for death. I welcome any alternatives to opioads however alternative meds dont really work for me and i recently recieved a spinal implant in the lower back which does sooth and benefit me a small amount but i have cognative memory disorder (dementia) and am constantly losing my charger or controller .THe truth about pain medicine is that narcotics really work the best and are fast acting .This remedy called opioads is the the last step in pain control while they have become so controversal and publicised the common people have to fight for the right to use them which is a right not a priviledge !Grandfathers and mothers mostly elderly people like me who are at the end of life and desire to remain independant and mobile are now singled out as addicts and make up the largests slot on the over population scale. We are, according to the United nations and there agenda 2130 , undesirables and need to go, in order to balance the future of humans and our numbers and resources for future generations .Thank y

David W Mitchell

Another study should be done with current data. In 2020, no doctor will prescribe opiates unless you are scheduled to die within a year.

Corrections: as if we HAVEN’T a brain in our heads or rights. Lol
Was listening to stereo & voice to tx at once.😉

I have no doubt that NIH would make such a bogus report. 30 yrs ago & 20 yrs ago still nsaids was 1st drug to be prescribed by G.P & rheumatologist. The 2nd treatment in the same timeframe by the same Physicians was physical therapy. Not once but numerous times or different brands NSAIDs before even being allowed to go to P.M. P.M would make u repeat all said treatments plus see psychiatrist before ever prescribing opiates and then it usually was a low mg 3 × a day & only one opiate not more & steroid injections more often than allowed now. I spoke w/ a running for law director about chronic pain people plight. He said, “its not a popular conversation to have & thats why no lawyer would take it on bc of gov agencies cdc,fda, dea.” I said, “these agenties should put doctors only on the cspd not patients bc we didn’t go to school to learn how prescribe & we are trusting in their professional wisdom but we r the ones paying higher fees & treated as criminals being sandwich between insurers,doctors, pharmacist as if we have brain in our head or rights. Needless to say he wanted off the phone.

Jeanette French

Publishing this at this time after the fact , on these numbers is a another huge mistake and another huge blow to pain patients. This is so very wrong. How many nails do you intend to drive into our coffins. Really ???………..I can assure you that doctors today are NOT prescribing pain medications as indicated in this study. All doctors today have had the fear of losing their license put into their lives, as well as warning letters when they did prescribe them. Many have left this field of practice and some states no longer even have pain clinics due to this whole mess . Publishing a study like this at this time is very poor judgement on the part of any institution. Your timing could not be any worse, as the issue you are referring to has been over corrected and now you publish this. Patients have taken their lives over under controlled/ under treated pain in the wake of this, really? Alternative methods have been instated for first pain complaints now. Very poor judgement on the publishing of this article. Some one has had their head in the sand for many years.

Jeanette French

Hi, I find this a bit hard to believe as in my experience any doc I have seen in the last couple years usually leads the conversation with I do not prescribe pain medications, I have seen many many docs and I find this very hard to believe. I think that something in this study is not right, numbers, something. I just do not believe this. Doctors have been in fear of losing their license over prescribing pain medications so you really think they would do this, especially primary care docs at this time in this debate, No way !…I can say something in this study does NOT ring true here.

Cody

I have very various painful health issues from fibromyalgia to chronic fatigue syndrome, spinal stenosis, degenerative disc disease, three broken vertebrae and three bulging disc, arthritis, osteoporosis, hemiplegic migraine‘s and a bone fragment pressing on my spinal cord causing severe pain and a right knee ACL tear. No doctor will do surgery on my back or knee because I am a stroke risk due to a stroke in 2018. I am told that since I have nothing that will kill me they will not risk any surgery to help relieve any pain. The VA has told me over and over that unless I have stage four cancer and I am expected to die within a few weeks they will not prescribe any pain medication whatsoever. I am at the end of my rope and literally suicidal most of the time because I can’t live like this! And they wonder why veterans commit suicide!

Cher

Thank you for the info Ed! This info rings true with me, since I get my pain med from my family Dr. When I went to my neurosurgeon, he thought I was on strong meds. If only he could feel my torturous pain. Now my Dad has Cancer and his first cancer Dr declined him any pain meds. I was shocked by that. He has an appt with a more specialized oncologist, so hopefully he can give him something. I thought cancer Dr were suppose to be the ones who could prescribe pain meds more freely?

Mary

Sometimes Musculoskeletal pain can start out way beyond the non drug remedies. Particularly since illnesses like rheumatoid arthritis can take years to diagnose, and the pain is at horrific level. I worked out 5 days a week and got sudden severe onset RA. Within one week I could barely walk. There were no effective pain pills way back then, and I fought suicide for over a year, until biologicals were invented.

HOWARD HILL

A lot of seniors are dying literally from pain anxiety, because of the so called opioid crisis
The crisis is the people needing meds can’t get any help. Then they are legalized pot a mind altering drug. This is do wrong, more people will forbid the roads from pot, people taking the pain meds as prescribed are not mind altered

Deb

Do we know WHY doctors made those choices? I don’t know where the data came from, but believe we must be aware the physicians, more than likely, had good reason to prescribe as they did. This viewpoint is because overall prescribing for opioids has gone way down.

Until we understand the complete circumstances, numbers can be viewed any way you want to present the data!

Sandra

This is is based on information analyzed from 2007 to 2015. Based on that timeline, this is already out of date and isn’t likely to be an accurate reflection on the prescribing of opioids. We all know much greater restrictions began in 2016 due to the new opioid guidelines. I realize data always runs behind because it takes time to collect data but in this particular situation, the changes that have come about since the 2016 guidelines would likely be far removed from 2007-2015.

Martha

Note: this “new” study ended in 2015….
prior to the draconian CDC “guideline” for opiates. We all know the cruel damage that report generated, interpreted as ‘law’s by a majority of physicians in the U.S.
An interesting study, but 5 years to extrapolate the data & publish???
Good grief.

Gail Honadle

Pain meds is all that works. OA drugs rip your GI and Esophagus up. OTC crap is just that, and is dangerous causing other health issues. To much Tylenol will get your liver, rest thin the blood and destroy GI tract. Learn what medicines do and what the side effects are. And NO you don’t get high on today’s Pain meds.

J. A.

How does one convince a doctor that they are experiencing chronic pain, musculoskeletal in nature and had previously (13 yrs)been rx’d opiate ANALGESICS, carisoprodol and PT for pain moderation? I’ve had escalation of chronic pain issues and advancing arthritis since 1998 due to a MVA where I had reduction surgery (plates, screws) put in place which became displaced due to surgical negligence ( impossible to place blame on doctors, god complex maybe? ). Over 22 yrs and 3 prescribing doctors, now I have no way to convince doctors that I need opiate analgesics to help with chronic pain. Never abused medication, diverted medication….
I’m giving up. My previous life was very satisfying but after the MVA. everything did a 180% turn around. Nothing matters anymore.
Pain as a vital sensory indicator means nothing. Documentation means nothing…so the only option I have is to find illicit drugs and hope they aren’t going to actually cause an OD death.

Danny

2004 – 2015? The data is from 4 years ago!

LMC

Maybe these learned scholars are as confused by OUD as us laymen. Opioid Use Disorder is a tag placed on Chronic Pain Suffers that most of us don’t know about until we request doctor notes and actually read them. The definition practically reads: drug addict that requests opioids instead of meditating.

I firmly believe that most if these types if “studies” are inaccurate and surface.

Steven

This is just misinformation to disguise the government killing machine. No long term opiod use is being started. 90 mme is it if you are lucky. If you wa y to believe something half of all ppl are gone in 4 years. 100000.RIP we will meet again.

Lisa

Absolutely do not believe this article. Doctors do not prescribe opioids for ANY kind of pain these days