Analgesic prescribing trends in a national sample of older veterans with osteoarthritis: 2012-2017

Abstract

Few investigations examine patterns of opioid and nonopioid analgesic prescribing and concurrent pain intensity ratings before and after institution of safer prescribing programs such as the October 2013 Veterans Health Administration system-wide Opioid Safety Initiative (OSI) implementation. We conducted a quasi-experimental pre–post observational study of all older U.S. veterans (≥50 years old) with osteoarthritis of the knee or hip. All associated outpatient analgesic prescriptions and outpatient pain intensity ratings from January 1, 2012 to December 31, 2016, were analyzed with segmented regression of interrupted time series. Standardized monthly rates for each analgesic class (total, opioid, nonsteroidal anti-inflammatory drug, acetaminophen, and other study analgesics) were analyzed with segmented negative binomial regression models with overall slope, step, and slope change. Similarly, segmented linear regression was used to analyze pain intensity ratings and percentage of those reporting pain. All models were additionally adjusted for age, sex, and race. Before OSI implementation, total analgesic prescriptions showed a steady rise, abruptly decreasing to a flat trajectory after OSI implementation. This trend was primarily due to a decrease in opioid prescribing after OSI. Total prescribing after OSI implementation was partially compensated by continuing increased prescribing of other study analgesics as well as a significant rise in acetaminophen prescriptions (post-OSI). No changes in nonsteroidal anti-inflammatory drug prescribing were seen. A small rise in the percentage of those reporting pain but not mean pain intensity ratings continued over the study period with no changes associated with OSI. Changes in analgesic prescribing trends were not paralleled by changes in reported pain intensity for older veterans with osteoarthritis.

Patients use fewer analgesics following supervised exercise therapy and patient education: an observational study of 16 499 patients with knee or hip osteoarthritis

“…While use of analgesics to address pain is common among patients with knee or hip OA, [5][6][7] guideline recommended first-line treatments 2 3 such as exercise therapy and patient education is greatly under-prescribed, 4 despite being associated with at least similar pain relief as the most commonly used analgesics. 2 27 28 Our observational results suggest that exercise therapy and patient education may not only provide pain relief, but may reduce analgesic use.…”

“…4 Instead, analgesics such as paracetamol (acetaminophen) and non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to address pain associated with knee or hip OA. [5][6][7] A large proportion of patients are also prescribed opioids for their knee and hip OA pain. [8][9][10] Exercise therapy appears to have similar effect sizes to reduce OA pain as the small to moderate effect size of paracetamol and NSAIDs, 2 and a recent study suggested that opioids are not superior to NSAIDs in reducing low back pain and knee and hip OA pain.…”

Osteoarthritis year in review 2020: epidemiology & therapy

“…The study by Trentalange et al 88 used an interrupted time-series, segmented regression model applied to data from the US national Veterans Health Administration in patients aged 50 years and over with a recorded diagnosis of hip or knee OA. Aggregated monthly prescription rate data were available 22 months before and 38 months after the introduction of the national system-wide Opioid Safety Initiative (OSI) in October 2013.…”

Pain Intensity and Trajectory Following Intra-Articular Injection of Mono-Iodoacetate in Experimental Osteoarthritis: A Meta-Analysis of In Vivo Studies

“… 1 , 2 With pain as the predominant symptom of OA, 3 - 5 a growing emphasis of research and clinical practices is being put on pain management. Despite existing drugs such as acetaminophen, opioids, and non-steroidal anti-inflammatory drugs (NSAIDs) being widely used, 6 - 8 to date, there is no analgesic present for OA pain alleviation proven both safe and robustly effective, and the associated adverse effects (AEs) were reported to affect a spectrum of body systems. 9 - 11 Thus, a stringent need for new pain-relieving drugs for OA warrants further investigation in this field.…”