Eighteen-Year Trends in the Prevalence of, and Health Care Use for, Noncancer Pain in the United States: Data from the Medical Expenditure Panel Survey

Abstract

We used data from the nationally representative Medical Expenditure Panel Survey to determine the 18-year trends in the overall rates of noncancer pain prevalence and pain-related interference, as well as in health care use attributable directly to pain management. The proportion of adults reporting painful health condition(s) increased from 32.9% (99.7% confidence interval [CI] = 31.6–34.2%;120 million adults) in 1997/1998 to 41.0% (99.7% CI = 39.2–42.4%; 178 million adults) in 2013/2014 (Ptrend < .0001). Among adults with severe pain-related interference associated with their painful health condition(s), the use of strong opioids specifically for pain management more than doubled from 11.5% (99.7% CI = 9.6–13.4%) in 2001/2002 to 24.3% (99.7% CI = 21.3–27.3%) in 2013/2014 (Ptrend < .0001). A smaller increase (Pinteraction < .0001) in strong opioid use was seen in those with minimal pain-related interference: 1.2% (99.7% CI = 1.0–1.4%) in 2001/2002 to 2.3% (99.7% CI = 1.9–2.7%) in 2013/2014. Small but statistically significant decreases (Ptrend < .0001) were seen in 1) the percentage of adults with painful health condition(s) who had ≥1 ambulatory office visit for their pain: 56.1% (99.7% CI = 54.2–58.0%) in 1997/1998 and 53.3% (99.7% CI = 51.4–55.4%) in 2013/2014; 2) the percentage who had ≥1 emergency room visit for their pain; 9.9% (99.7% CI = 8.6–11.2%) to 8.8% (99.7% CI = 7.9–9.7%); and 3) the percentage with ≥1 overnight hospitalization for their pain: 3.2% (99.7% CI = 2.6–4.0%) to 2.3% (99.7% CI = 1.8–2.8%). PerspectiveOur data illustrate changes in the management of painful health conditions over the last 2 decades in the United States. Strong opioid use remains high, especially in those with severe pain-related interference. Additional education of health care providers and the public concerning the risk/benefit ratio of opioids appears warranted.