After the Centers for Disease Control and Prevention issued a guideline for prescribing opioids to patients experiencing chronic pain in 2016, the prescribing frequency of non-opioid painkillers increased each year beyond what could be expected based on pre-existing trends. , a new study finds.
The 2016 guideline aimed to help U.S. clinicians treat adult patients for chronic pain while weighing the benefits and risks of prescribing opioids, as more Americans died of opioid-related overdose. Using data on insurance claims from over 15 million patients, a team of researchers from Michigan Medicine and the CDC analyzed the prescription rate of nonopioid painkillers, such as acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs).
They found that the odds of prescribing a nonopioid pain medication in 2016 were 3% higher than expected from pre-guideline estimates for the same year. That number rose to 8% in 2017 and 9.7% in 2018. The results are published in the JAMA Network Open.
“These results suggest that clinicians have been prescribing nonopioid pain medication more frequently since the 2016 guideline was issued, and this may mean that they have only considered opioid treatment if its expected benefits outweighed the expected risks to the patient,” said Jason Goldstick. Ph.D., lead author of the study and research associate professor of emergency medicine at the University of Michigan Medical School.
“Although many characteristics – such as pain intensity and effectiveness of pain management – are not available in these data, these results may represent an increase in guideline-compliant pain management.”
The increase in prescribing of nonopioid pain medication coincided with a significant decrease in opioid prescription during the same period, which is consistent with other research showing reductions in opioid prescription according to the 2016 guidelines. Increases in prescribing of nonopioid analgesics were consistent across several patient subpopulations, including those with recent opioid exposure, as well as those with anxiety or mood disorders.
“The 2016 guideline encouraged caution in prescribing opioids, and it was possible that it could have reduced the use of pain therapies in general,” said Amy Bohnert, Ph.D., MHS, senior author of the paper and associate professor of psychiatry at UM School of Medicine. “Our analysis provides an encouraging indication that patients were more often offered other treatments for pain than before the guideline, rather than only being offered opioids less frequently.”
Researchers say the changes in prescription may also have led to a shift toward the use of some non-pharmacological treatments, including physiotherapy and cognitive behavioral therapy. They note that further research into changes in non-pharmacological pain management as well as undertreatment of pain and patient pain outcomes is needed to gain a better understanding of changes in the pain management landscape following the 2016 Guideline Release.
“Multimodal and multidisciplinary approaches to pain management that address each person’s biological, psychological, and social characteristics are a critical part of a comprehensive treatment protocol,” the researchers wrote. “Further analysis can help identify the pathways through which pain relief can be optimized.”
Additional authors include Matthew G Myers, MPH, of Michigan Medicine, and Gery P. Guy, Ph.D., MPH, Jan L. Losby, Ph.D., MSW, and Grant T. Baldwin, Ph.D., MPH , the entire CDC
This work was funded in part by grants 19IPA1906094 (Dr. Goldstick), U01CE002780 (Dr. Bohnert) and R49CE003085 from the Centers for Disease Control and Prevention.
Cited paper: “Patterns in prescribing nonopioid painkillers following the release of the 2016 guideline for prescribing opioids for chronic pain,” JAMA Network Open. DOI: 10.1001 / jamanetworkopen.2022.16475