Obesity and Incident Prescription Opioid Use in the U.S., 2000–2015

Stokes, Andrew; Lundberg, Dielle J.; Hempstead, Katherine; Berry, Kaitlyn M.; Baker, Joshua F.; Preston, Samuel H.

doi:10.1016/j.amepre.2019.12.018

Cited by 28 publications

(18 citation statements)

References 49 publications

(35 reference statements)

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“…21,60 While our study suggests that individuals with obesity are unlikely to be under-treated for pain, over-treatment, if it is the case, would be concerning because, in contrast to recommended preventive care, increased receipt of opioids is a risk factor for undesirable health outcomes (e.g., overdose). 67 While obesity has been implicated in increased prevalence of pain and pain medication use, 40,68 our study focuses, instead, on whether there are disparities in the treatment of pain by restricting the sample to those with back pain and adjusting for pain interference. Future work should consider of other conditions that warrant treatment with Rx pain medication and whether patients with obesity could, in fact, be overtreated for pain.…”

Section: Discussionmentioning

confidence: 99%

“…[32][33][34][35][36][37][38] Recent studies have shown a positive association between obesity and opioid use in the general population, presumably due to a higher prevalence of pain among those who are obese. 39,40 The studies focus on overall use irrespective of need or conditions, which does not speak to disparities in treatment. To focus on potential treatment disparities, we restrict our sample to persons with a given source of pain (back pain) and examine whether they received a pain prescription as treatment.…”

Section: Introductionmentioning

confidence: 99%

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Obesity and the Receipt of Prescription Pain Medications in the US

Cho

Chang

2021

J GEN INTERN MED

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BACKGROUND:Little is known about disparities in pain treatment associated with weight status despite prior research on weight-based discrepancies in other realms of healthcare and stigma among clinicians. OBJECTIVE: To investigate the association between weight status and the receipt of prescription analgesics in a nationally representative sample of adults with back pain, adjusting for the burden of pain. DESIGN: Cross-sectional analyses using the Medical Expenditure Panel Survey (2010-2017). PARTICIPANTS: Five thousand seven hundred ninetyone civilian adults age ≥ 18 with back pain. MAIN MEASURES: We examine the odds of receiving prescription analgesics for back pain by weight status using logistic regression. We study the odds of receiving (1) any pain prescription, (2) three pain prescription categories (opioid only, non-opioid only, the combination of both), and (3) opioids conditional on having a pain prescription. KEY RESULTS: The odds of receiving pain prescriptions increase monotonically across weight categories, when going from normal weight to obesity II/III, despite adjustments for the burden of pain. Relative to normal weight, higher odds of receiving any pain prescription is associated with obesity I (OR = 1.30 [95% CI = 1.04-1.63]) and obesity II/III (OR = 1.72 [95% CI = 1.36-2.18]). Obesity II/III is also associated with higher odds of receiving opioids only (OR = 1.53 [95% CI = 1.16-2.02]), non-opioids only (OR = 1.77 [95% CI = 1.21-2.60]), and a combination of both (OR = 2.48 [95% CI = 1.44-4.29]). Obesity I is associated with increased receipt of non-opioids only (OR = 1.55 [95% CI = 1.07-2.23]). Conditional on having a pain prescription, the odds of receiving opioids are comparable across weight categories. CONCLUSIONS: This study suggests that, relative to those with normal weight, adults with obesity are more likely to receive prescription analgesics for back pain, despite adjustments of the burden of pain. Hence, the possibility of weight-based undertreatment is not supported. These findings are reassuring because individuals with obesity generally experience a higher prevalence of back pain. The possibility of over-treatment associated with obesity, however, may warrant further investigation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Obesity and the Receipt of Prescription Pain Medications in the US

Cho

Chang

2021

J GEN INTERN MED

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“…Dependent variable: parents were classified as having chronic noncancer pain (CNCP) if, during the second interview round of each survey year, they communicated one or more conditions associated with chronic pain identified through ICD-9 and Clinical Classification Codes. The selection of these codes was informed by clinical expertise as well as by other studies that have identified chronic pain associated conditions in MEPS [10][11][12] (see Supplementary Digital Content A for list of ICD-9 codes, Supplemental Digital Content 1, http://links.lww.com/MLR/C413).…”

Section: Variablesmentioning

confidence: 99%

Caregiver Burden in Caregivers of Children With Special Health Care Needs and Association With Chronic Pain

et al. 2022

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Background/Objectives: Chronic noncancer pain (CNCP) affects millions of individuals in the United States but evidence of its prevalence among caregivers of children with special health care needs is sparse. We sought to estimate the prevalence of CNCP and its association with caregiver burden, in a nationally representative sample.Methods: Retrospective cross-sectional study using pooled Medical Expenditure Panel Survey data for 2010-2015. Within interviewed households, family groups consisting of at least 1 parent and 1 child (0-17 y) were identified. CNCP was identified by one or more International Classification of Diseases, Ninth Revision (ICD-9)-CM codes utilizing previously published approaches. Level of caregiver burden was defined using a validated screener questionnaire identifying children with high burden of care (ie, special health care needs), for example, high or low burden. We estimated prevalence of CNCP as a function of caregiver burden, as well as the association of risk factors with CNCP, including parent sociodemographic features, clinical diagnoses, and family level characteristics.Results: We identified 46,525 caregivers of whom 3.6% reported experiencing high caregiving burden. The prevalence of CNCP was 25.5% and 14.0% among parents with high compared with low caregiving burden, respectively. Odds of CNCP were higher among parents with high compared to those with lower caregiver burden (odds ratio = 1.29, 95% confidence interval = 1.06-1.55). Being obese, experiencing disability, and having a mental health diagnosis were associated with higher odds of CNCP.Conclusions: Chronic pain is more common among caregivers with high caregiver burden. Our findings highlight the need to further explore the nature and impact of risk factors on caregiver health and disability.

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“…Although obesity has been associated with increased prescription opioid use in the general population ( Stokes et al., 2020 ), this association is not evident in pregnant women ( Whiteman et al., 2014 ). Conversely, pregnant women with opioid use disorders are more likely to be underweight ( Nagarajan and Goodman, 2020 ).…”

Section: Maternal Opioid Usementioning

confidence: 99%

Improving translational relevance: The need for combined exposure models for studying prenatal adversity

Smith

2021

Brain, Behavior, & Immunity - Health

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Prenatal environmental adversity is a risk factor for neurodevelopmental disorders (NDDs), with the neuroimmune environment proposed to play a role in this risk. Adverse maternal exposures are associated with cognitive consequences in the offspring that are characteristics of NDDs and simultaneous neuroimmune changes that may underlie NDD risk. In both animal models and human studies the association between prenatal environmental exposure and NDD risk has been shown to be complex. Maternal overnutrition/obesity and opioid use are two different examples of complex exposure epidemics, each with their own unique comorbidities. This review will examine maternal obesity and maternal opioid use separately, illustrating the pervasive comorbidities with each exposure to argue a need for animal models of compound prenatal exposures. Many of these comorbidities can impact neuroimmune function, warranting systematic investigation of combined exposures to begin to understand this complexity. While traditional approaches in animal models have focused on modeling a single prenatal exposure or second exposure later in life, a translational approach would begin to incorporate the most prevalent co-occurring prenatal exposures. Long term follow-up in humans is extremely challenging, so animal models can provide timely insight into neurodevelopmental consequences of complex prenatal exposures. Animal models that represent this translational context of comorbid exposures behind maternal obesity or comorbid exposures behind maternal opioid use may reveal potential synergistic neuroimmune interactions that contribute to cognitive consequences and NDD risk. Finally, translational co-exposure models can identify concerning exposure combinations to guide treatment in complex cases, and identify high risk children starting in the prenatal period where early interventions improve prognosis.

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Obesity and Incident Prescription Opioid Use in the U.S., 2000–2015

Cited by 28 publications

References 49 publications

Obesity and the Receipt of Prescription Pain Medications in the US

Obesity and the Receipt of Prescription Pain Medications in the US

Caregiver Burden in Caregivers of Children With Special Health Care Needs and Association With Chronic Pain

Improving translational relevance: The need for combined exposure models for studying prenatal adversity

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