Chronic pain diagnoses and opioid dispensings among insured individuals with serious mental illness

Abstract

Background Individuals with major depressive disorder (MDD) and bipolar disorder (BD) have particularly high rates of chronic non-cancer pain (CNCP) and are also more likely to receive prescription opioids for their pain. However, there have been no known studies published to date that have examined opioid treatment patterns among individuals with schizophrenia.Methods Using electronic medical record data across 13 Mental Health Research Network sites, individuals with diagnoses of MDD (N=65,750), BD (N=38,117) or schizophrenia or schizoaffective disorder (N=12,916) were identified and matched on age, sex and Medicare status to controls with no documented mental illness. CNCP diagnoses and prescription opioid medication dispensings were extracted for the matched samples. Multivariate analyses were conducted to evaluate (1) the odds of receiving a pain-related diagnosis and (2) the odds of receiving opioids, by separate mental illness diagnosis category compared with matched controls, controlling for age, sex, Medicare status, race/ethnicity, income, medical comorbidities, healthcare utilization and chronic pain diagnoses.Results Multivariable models indicated that having a MDD (OR=1.90; 95% CI=1.85–1.95) or BD (OR=1.71; 95% CI=1.66–1.77) diagnosis was associated with increased odds of a CNCP diagnosis after controlling for age, sex, race, income, medical comorbidities and healthcare utilization. By contrast, having a schizophrenia diagnosis was associated with decreased odds of receiving a chronic pain diagnosis (OR=0.86; 95% CI=0.82– 0.90). Having a MDD (OR=2.59; 95% CI=2.44–2.75) or BD (OR=2.12; 95% CI=1.97–2.28) diagnosis was associated with increased odds of receiving chronic opioid medications, even after controlling for age, sex, race, income, medical comorbidities, healthcare utilization and chronic pain diagnosis; having a schizophrenia diagnosis was not associated with receiving chronic opioid medications.Conclusions Individuals with serious mental illness, who are most at risk for developing opioid-related problems, continue to be prescribed opioids more often than their peers without mental illness. Mental health clinicians may be particularly well-suited to lead pain assessment and management efforts for these patients. Future research is needed to evaluate the effectiveness of involving mental health clinicians in these efforts.

Prevalence and treatment of neuropathic pain diagnoses among U.S. nursing home residents

“…Using Medicare claims and information on the MDS active diagnoses section for assessments conducted between January 1, 2016, and November 30, 2016, we defined neuropathic pain diagnoses based on at least 1 primary or secondary ICD-10-CM diagnosis code for any of the following conditions 6,32 : diabetic neuropathy, back and neck pain with neuropathic involvement, spinal cord injury, facial nerve disorders, postherpetic neuralgia or neuropathy, hereditary or idiopathic neuropathy, neuralgia, upper or lower limb neuropathies, unspecified mononeuropathy or polyneuropathy, and other conditions associated with neuropathic pain (Appendix 1, available online as supplemental digital content at http://links.lww.com/PAIN/B527). Residents with any of these codes were classified as having neuropathic pain.…”

Efficacy and safety of strong opioids for chronic noncancer pain and chronic low back pain: a systematic review and meta-analyses

“…Furthermore, most studies excluded patients with current or past substance abuse, severe comorbidities, and MH disorders, limiting generalizability of the results as patients with MH illness, particularly depressive and anxiety disorders, show high rates of CNCP and are also often prescribed opioids for pain relief in practice. 11,25,70 In addition, most study participants in the included studies were women of middle age, further limiting the generalizability of our findings. It has been shown, however, that older patients are among the groups most likely to use opioids long term (≥1 year), 85 and opioid prescribing seems to be highest (25%) among the elderly (≥65 years).…”

Risk of Suicide in Patients With Bipolar Disorder Having Comorbid Chronic Pain Disorders

“…However, these differences were not clinically significant (Failde et al, 2013). Likewise, Owen-Smith et al (2020) found that most patients with CPD and BD were older, of the female sex, and racially white. Moreover, they also noticed a clinically significant increase in chronic opioid use and total health care utilization in the last 6 months in CPD and BD patients compared with the control group (Owen-Smith et al, 2020).…”

“…Physical comorbidity is frequent in BD patients and nearly four pain complaints at any one time were reported (Maina et al, 2013; Stubbs et al, 2015). Furthermore, there is an association between BD diagnosis and chronic pain disorder (CPD) (Owen-Smith et al, 2020). In a meta-analysis, the prevalence of pain in BD was 28.9% (Stubbs et al, 2015).…”