Abstract
Monitoring trends in prescription analgesic use among adults with musculoskeletal conditions provides insight into how changing prescribing practices, guidelines, and policy measures may affect those who need pain management. To evaluate trends in prescription opioid use and nonopioid analgesic use among adults with functional limitations attributable to musculoskeletal conditions. This repeated cross-sectional study uses data from the National Health and Nutrition Examination Study from 1999 to 2016. Data were analyzed from January to July 2019. The participants were adults aged 30 to 79 years who reported functional limitations due to back or neck problems and/or arthritis or rheumatism. Any use of a prescription opioid or exclusive use of a prescription nonopioid analgesic. In this population of 7256 adults with 1 or more functional limitations attributable to a musculoskeletal condition (4226 women [59.9%]; 3508 [74.4%] non-Hispanic white individuals; median [interquartile range] age, 63 [53-70] years), opioid use and exclusive nonopioid analgesic use exhibited approximately reciprocal patterns of change from 1999 to 2016. Opioid use increased significantly (difference in prevalence for 2015-2016 vs 1999-2000, 7.2%; 95% CI, 1.3% to 13%; P for trend = .002), and exclusive use of nonopioid analgesics decreased significantly (difference in prevalence for 2015-2016 vs 1999-2000, -13%; 95% CI, -19% to -7.5%; P for trend < .001) during this period. The increase in any opioid use was driven by long-term rather than short-term use. A crossover in the prevalence of opioid use and exclusive use of nonopioid analgesics occurred between 2003 and 2006, after which opioid use was more prevalent. Between 2013 and 2016, decreases in opioid use were observed among men (difference in prevalence for 2015-2016 vs 2013-2014, -11%; 95% CI, -21% to 1.8%) and participants with less than a high school education (difference, -15%; 95% CI, -24% to -6.1%). During this same period, exclusive nonopioid analgesic use also decreased markedly across the population (difference, -5.3%; 95% CI, -9.1% to -1.5%). The substitution of opioids for nonopioid analgesics between 2003 and 2006 may have occurred as evidence emerged on the cardiovascular risks associated with nonopioid analgesics. Reductions in opioid use between 2013 and 2016 were most substantial among those with low socioeconomic status, who may encounter barriers in accessing alternatives. Despite those decreases, opioid use remained more prevalent in 2015 to 2016 than in 1999 to 2000, suggesting a potentially long tail for the opioid epidemic.
Highlights
Musculoskeletal conditions are a major source of persistent pain and functional limitation and are associated with substantial health care spending in the United States.[1,2] Musculoskeletal conditions are the leading cause of years lived with disability[3] and were the third leading cause of disabilityadjusted life-years after cardiovascular disease and cancer in the United States in 2016.3In the first decade of the 21st century, opioid therapy for musculoskeletal pain and other chronic noncancer pain conditions expanded rapidly.[4]
Opioid use increased significantly, and exclusive use of nonopioid analgesics decreased significantly during this period
Meaning Substitution of opioids for nonopioid analgesics may have occurred as evidence emerged on the cardiovascular risks associated with nonopioid analgesics, and despite recent decreases, opioid use remained more prevalent in 2016 than in 1999
Summary
Musculoskeletal conditions are a major source of persistent pain and functional limitation and are associated with substantial health care spending in the United States.[1,2] Musculoskeletal conditions are the leading cause of years lived with disability[3] and were the third leading cause of disabilityadjusted life-years after cardiovascular disease and cancer in the United States in 2016.3In the first decade of the 21st century, opioid therapy for musculoskeletal pain and other chronic noncancer pain conditions expanded rapidly.[4]. Prescribing trends have been described in aggregate, it is less clear how prescription analgesic use patterns have evolved in individuals living with functional limitations attributable to musculoskeletal conditions. Monitoring such trends provides insights into how changing prescribing practices, guidelines, and policy measures may affect those who need long-term pain management. A growing body of evidence indicates that long-term opioid use has limited efficacy for musculoskeletal pain[10] and that nonopioid treatments, including self-care strategies and nonpharmacologic interventions, improve function and health,[11] pharmacologic therapy including opioid use remains prevalent,[12] and barriers to nonpharmacologic interventions may delay their adoption.[13]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
