Population-Level Trends in Adult Pain Treatments, 2011-2019

Abstract

<h3>Research Objectives</h3> To (i) compare the annual utilization of nonpharmacologic pain treatments versus prescription opioids among cancer-free adults, (ii) estimate the annual use of acupuncture, chiropractic care, massage therapy, occupational therapy, and physical therapy, (iii) determine whether calendar year was associated with treatment type, and (iv) explore whether pain treatments varied by pain severity. <h3>Design</h3> A trend analysis of 2011-2019 cross-sectional data. <h3>Setting</h3> Outpatient pain treatments were derived from the nationally representative Medical Expenditure Panel Survey. <h3>Participants</h3> We included U.S. adults (age ≥ 18) with self-reported pain limiting their daily work or household activities according to the Veteran's RAND-12. Participants were excluded if they had a 3-digit International Classification of Disease 9 (140-239) or 10 (C00-D49) code for cancer because cancer pain calls for different prescribing practices. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> The primary outcome was the annual prevalence of mutually exclusive pain treatments (opioids only, vs. nonpharmacologic alternatives only, vs. both, vs. none). A secondary outcome was the annual prevalence of any acupuncture, chiropractic care, massage therapy, occupational therapy, or physical therapy. <h3>Results</h3> Overall, 73,396 unweighted respondents were included. Analyses were stratified by whether respondents underwent surgery (20.5% weighted) or not (79.5% weighted) in the year of their pain treatment. After controlling for demographic factors, socioeconomic status, health conditions, and pain severity, the use of prescription opioids alone decreased in 2019 (non-surgical, adjusted Odds Ratio [aOR], 0.74; [95% CI, 0.63-0.86]; surgical, aOR, 0.59; [95% CI, 0.47-0.74]) compared to 2011. Meanwhile, nonpharmacologic treatments increased in 2019 (non-surgical, aOR, 1.75; [95% CI, 1.49-2.05]; surgical, aOR, 1.82; [95% CI, 1.38-2.41]) compared to 2011. Chiropractic care and physical therapy were the most common nonpharmacologic treatment providers. Nonpharmacologic treatments did not vary based on pain severity. <h3>Conclusions</h3> The prevalence of nonpharmacologic treatments increased while prescription opioid use declined following policy and practice changes during the past decade. Nonpharmacologic pain treatments may be appropriate for all degrees of pain severity. <h3>Author(s) Disclosures</h3> No conflicts of interest have been reported.