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.

Genome-wide association study of treatment resistant depression highlights shared biology with metabolic traits

“…Depressive disorder was included as prior work in these health systems and others indicated that it is commonly applied by non-psychiatrists to capture MDD. We adopted this definition for consistency with numerous prior publications 8,39–41 applying electronic health records to the study of major depressive episodes. Among those patients, 467 (MGB: 242, VUMC: 225) had at least one procedural code for ECT.…”

Psychiatric risk factors for chronic high-dose opioid prescribing: register-based cohort study

“…Our findings align with previous cross-sectional studies indicating an association between opioid misuse and psychiatric disorders. 18 , 19 Several mechanisms might explain this association. For example, the emotional distress associated with psychiatric disorders might predispose to chronic pain and subsequently prolonged opioid use.…”

“…These findings contrast with previous research showing decreased pain sensitivity in people with a psychotic disorder. 22 , 23 Furthermore, Owen et al 19 found that people with psychotic disorders are less often diagnosed with chronic pain conditions and less often receive opioids than the general population. A potential explanation for the discrepancies between the results of Owen et al and our data is a difference in study design.…”

Multimorbidity clusters among people with serious mental illness: a representative primary and secondary data linkage cohort study

“…However, there is an increasing recognition that chronic pain and mental illness tends to co-occur, with approximately 33% of patients with SMI (Stubbs et al, 2014) experiencing chronic pain. High rates of chronic pain have also been reported by patients with major depressive disorders and bipolar disorders (Owen- Smith et al, 2020;Stubbs et al, 2015aStubbs et al, , 2015bStubbs et al, , 2015c. However, chronic pain has received little attention in people with SMI, despite reduced pain sensitivity (Stubbs et al, 2015a(Stubbs et al, , 2015b(Stubbs et al, , 2015c) and higher severity of pain (Strassnig, Brar, & Ganguli, 2003) reported by people with schizophrenia.…”