Prevalence of Pain Management Techniques Among Adults With Chronic Pain in the United States, 2019

Groenewald, Cornelius B.; Murray, Caitlin B.; Battaglia, Marco; Scaini, M Simona; Quinn, Patrick D.

doi:10.1001/jamanetworkopen.2021.46697

Cited by 28 publications

(20 citation statements)

References 6 publications

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“…With respect to socioeconomic status (SES), prior work has consistently found higher POU among lower-SES adults [ 5 , 9 , 53 , 55 ]. What our analysis contributes is that food insecurity and employment status are more salient predictors of POU use than the more commonly used SES measures of education or income, which were largely not significant net of these other covariates.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and correlates of prescription opioid use among US adults, 2019–2020

et al. 2023

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This study estimates the prevalence of prescription opioid use (POU) in the United States (US) in 2019–2020, both in the general population and specifically among adults with pain. It also identifies key geographic, demographic, and socioeconomic correlates of POU. Data were from the nationally-representative National Health Interview Survey 2019 and 2020 (N = 52,617). We estimated POU prevalence in the prior 12 months among all adults (18+), adults with chronic pain (CP), and adults with high-impact chronic pain (HICP). Modified Poisson regression models estimated POU patterns across covariates. We found POU prevalence of 11.9% (95% CI 11.5, 12.3) in the general population, 29.3% (95% CI 28.2, 30.4) among those with CP, and 41.2% (95% CI 39.2, 43.2) among those with HICP. Findings from fully-adjusted models include the following: In the general population, POU prevalence declined about 9% from 2019 to 2020 (PR = 0.91, 95% CI 0.85, 0.96). POU varied substantially across US geographic regions: It was significantly more common in the Midwest, West, and especially the South, where adults had 40% higher POU (PR = 1.40, 95% CI 1.26, 1.55) than in the Northeast. In contrast, there were no differences by rural/urban residence. In terms of individual characteristics, POU was lowest among immigrants and among the uninsured, and was highest among adults who were food insecure and/or not employed. These findings suggest that prescription opioid use remains high among American adults, especially those with pain. Geographic patterns suggest systemic differences in therapeutic regimes across regions but not rurality, while patterns across social characteristics highlight the complex, opposing effects of limited access to care and socioeconomic precarity. Against the backdrop of continuing debates about benefits and risks of opioid analgesics, this study identifies and invites further research about geographic regions and social groups with particularly high or low prescription opioid use.

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Section: Discussionmentioning

confidence: 99%

Prevalence and correlates of prescription opioid use among US adults, 2019–2020

et al. 2023

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“…9 Previous studies often measured access to intervention techniques instead of to the licensed health care professionals 24 who treat pain in the clinical setting. 22,23,[25][26][27] Therefore, we defined nonpharmacologic treatments based on a policy brief 24 that identified the licensed health care professionals (acupuncturists, chiropractors, massage therapists, occupational therapists, and physical therapists) specialized in treating pain. 18,19 Operationalizing the workforce, instead of intervention techniques, helps establish a clear process for patient referral.…”

Section: Introductionmentioning

confidence: 99%

“…Trends in opioid use are well explicated, yet the Centers for Disease Control and Prevention (CDC) reported a need to contextualize treatment trends based on pain interference severity . Previous studies often measured access to intervention techniques instead of to the licensed health care professionals who treat pain in the clinical setting . Therefore, we defined nonpharmacologic treatments based on a policy brief that identified the licensed health care professionals (acupuncturists, chiropractors, massage therapists, occupational therapists, and physical therapists) specialized in treating pain .…”

Section: Introductionmentioning

confidence: 99%

Trends in the Use of Opioids vs Nonpharmacologic Treatments in Adults With Pain, 2011-2019

et al. 2022

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ImportanceChronic pain prevalence among US adults increased between 2010 and 2019. Yet little is known about trends in the use of prescription opioids and nonpharmacologic alternatives in treating pain.ObjectivesTo compare annual trends in the use of prescription opioids, nonpharmacologic alternatives, both treatments, and neither treatment; compare estimates for the annual use of acupuncture, chiropractic care, massage therapy, occupational therapy, and physical therapy; and estimate the association between calendar year and pain treatment based on the severity of pain interference.Design, Setting, and ParticipantsA serial cross-sectional analysis was conducted using the nationally representative Medical Expenditure Panel Survey to estimate the use of outpatient services by cancer-free adults with chronic or surgical pain between calendar years 2011 and 2019. Data analysis was performed from December 29, 2021, to August 5, 2022.ExposuresCalendar year (2011-2019) was the primary exposure.Main Outcomes and MeasuresThe association between calendar year and mutually exclusive pain treatments (opioid vs nonpharmacologic vs both vs neither treatment) was examined. A secondary outcome was the prevalence of nonpharmacologic treatments (acupuncture, chiropractic care, massage therapy, occupational therapy, and physical therapy). All analyses were stratified by pain type.ResultsAmong the unweighted 46 420 respondents, 9643 (20.4% weighted) received surgery and 36 777 (79.6% weighted) did not. Weighted percentages indicated that 41.7% of the respondents were aged 45 to 64 years and 55.0% were women. There were significant trends in the use of pain treatments after adjusting for demographic factors, socioeconomic status, health conditions, and pain severity. For example, exclusive use of nonpharmacologic treatments increased in 2019 for both cohorts (chronic pain: adjusted odds ratio [aOR], 2.72; 95% CI, 2.30-3.21; surgical pain: aOR, 1.53; 95% CI, 1.13-2.08) compared with 2011. The use of neither treatment decreased in 2019 for both cohorts (chronic pain: aOR, 0.43; 95% CI, 0.37-0.49; surgical pain: aOR, 0.59; 95% CI, 0.46-0.75) compared with 2011. Among nonpharmacologic treatments, chiropractors and physical therapists were the most common licensed healthcare professionals.Conclusions and RelevanceAmong cancer-free adults with pain, the annual prevalence of nonpharmacologic pain treatments increased and the prevalent use of neither opioids nor nonpharmacologic therapy decreased for both chronic and surgical pain cohorts. These findings suggest that, although access to outpatient nonpharmacologic treatments is increasing, more severe pain interference may inhibit this access.

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“…A number of evidence-based nonpharmacologic approaches to pain management are available, including non-opioid medications, restorative therapies (e.g., physical or occupational therapy), behavioral approaches, and complementary and integrative health (e.g., massage, acupuncture, yoga, tai-chi) (10). Unfortunately, these approaches are often under-utilized in clinical practice or not covered by insurance and many patients lack knowledge of or access to these treatments (10)(11)(12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

Implementation of a novel emergency department pain coach educator program: First year experience and evaluation

LeLaurin

Montague

Salloum

et al. 2023

Preprint

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Background: The ongoing opioid epidemic and rising number of patients with chronic pain have highlighted the need for alternative and integrative pain management approaches. A number of evidence-based nonpharmacologic pain management strategies are available; however, these approaches remain underutilized due to barriers such as time limitations, cost, and lack of clinician training. The aim of this work was to implement a nonpharmacologic pain coach educator program that addresses these barriers. We report an evaluation of the first year of program implementation in the emergency department of a large safety-net hospital. Methods:We implemented a multimodal pain coach educator program that included education on pain neuroscience and over-the-counter analgesic options, demonstration of integrative techniques, and nonpharmacologic toolkits for home use. Implementation strategies included electronic health record tools, training and promotion, clinical champions, and clinician recognition. We used the RE-AIM framework to guide evaluation of the first year of program implementation using data from the electronic health record, quantitative and qualitative program records, and patient-reported outcomes. Results:In the first year of program implementation 550 pain coach educator sessions were conducted. Upon immediate session completion, 61% of patients felt the program was helpful, 39% were unsure at the time, and none reported session was not helpful. Clinician feedback was overwhelmingly positive. Program cost per patient was $344.35. Adaptations to first year intervention and implementation strategies included modifications of session delivery timing for accommodation of clinical workflows, additions to program content to align with patient characteristics, and changes to patient identification strategies in response to the coronavirus 19 pandemic. Conclusions:The PAMI pain coach educator program provides a model for nonpharmacologic pain management programs which can be scaled up and adapted for other settings. This work demonstrates the importance of intervention and implementation strategy adaptations to enhance program reach and effectiveness.

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Prevalence of Pain Management Techniques Among Adults With Chronic Pain in the United States, 2019

Cited by 28 publications

References 6 publications

Prevalence and correlates of prescription opioid use among US adults, 2019–2020

Prevalence and correlates of prescription opioid use among US adults, 2019–2020

Trends in the Use of Opioids vs Nonpharmacologic Treatments in Adults With Pain, 2011-2019

Implementation of a novel emergency department pain coach educator program: First year experience and evaluation

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