The prescribing of opioid painkillers by doctors in the United States has nearly doubled over the past decade, according to a large new study that also found the use of safer alternatives for pain treatment was flat or declining.
Researchers at the Johns Hopkins Bloomberg School of Public Health analyzed a nationwide database of outpatient visits to doctors’ offices from 2000 to 2010. About 20% of the visits involved a primary diagnosis of pain.
“The overall prevalence of patient-reported pain has not changed during the past decade, although providers’ diagnoses of pain as a primary complaint nearly doubled,” said G. Caleb Alexander, MD, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness.
“Despite greater recognition of pain by providers and a remarkable increase in opioid prescribing, there was no commensurate increase in the prescribing of non-opioid therapies. This is particularly important because of the variety of alternative pharmacologic treatments available to treat nonmalignant pain.”
Researchers found that 11.3% of the visits in 2000 ended with the prescribing of an opioid pain medicine such as OxyContin or hydrocodone. A decade later the prescribing rate for opioids had grown to 19.6% of visits – a 73% increase.
Over the same period, the prescribing rate for non-opioid analgesics such as acetaminophen, aspirin, and non-steroidal anti-inflammatory medicines (NSAIDs) remained flat at about 29% of visits.
For new cases of musculoskeletal pain, the prescribing rate for non-opioid analgesics fell from 38% in 2000 to 29% in 2010.
“Despite large increases in opioid use, there were not similar increases in the prescribing of alternative analgesics, such as NSAIDs, acetaminophen, and other therapies that may serve as alternatives to prescription opioids. These results are important given the epidemic rates of prescription opioid abuse that have occurred in the context of efforts to improve the identification and treatment of nonmalignant pain,” said Alexander.
“There is little evidence to support any greater safety or effectiveness of opioids over many of these alternative analgesics, particularly with respect to functional outcomes and longer term use.”
The study by Alexander and his colleagues is one of the first to focus on trends in pain treatment in outpatient office and clinic visits.
“The majority of pain medications are prescribed by primary care physicians, who treat over half of the chronic pain patients in the United States. Pain specialists only treat a fraction of these patients,” said Matthew Daubresse, MHS, who is lead author of the study being published in the October issue of the journal Medical Care.
About 100 million adult Americans suffer from chronic pain. In recent years there has been a growing awareness in the medical community about the prevalence of pain. That awareness has coincided with a sharp increase in opioid use and abuse. By 2010, over 5 million people aged 12 years and older reported the non-medical use of pain relievers.
“We found that not only have the rates of treated pain not improved, but in many cases, use of safer alternatives to opioids, such as medicines like ibuprofen and acetaminophen, have either stayed flat or declined,” says Alexander. “This suggests that efforts to improve the identification and treatment of pain may have backfired, due to an over-reliance on prescription opioids that have caused incredible morbidity and mortality among patients young and old alike.”
“Policy-makers, professional organizations, and providers should re-evaluate prior efforts to improve the identification, treatment and management of non-malignant pain and promote approaches that adequately reflect the importance of non-opioid and non-pharmacologic treatments.”