Risk and Risk Factors for Chronic Opioid Use Among Opioid-Naive Patients With Newly Diagnosed Musculoskeletal Pain in the Neck, Shoulder, Knee, or Low Back

Abstract

Background. Musculoskeletal pain is a common condition, raising the concern these patients may transition to chronic opioid use. However, the incidence of and risk factors for chronic opioid use among patients with new musculoskeletal pain are not fully understood. Objective. To characterize the incidence and risk factors of chronic opioid use among opioid-naive patients with newly diagnosed musculoskeletal pain in the knee, neck, low back, and/or shoulder. Methods and Findings. The IBM® Marketscan® database provide health care utilization data for patients receiving private insurance through a participating employer or government organization. Compared to the general United States (US) population, the Marketscan® population is slightly more female and from the southern US, and less likely to come from the western US.(1) Using this data, we identified 518,195 privately insured, cancer-free, and opioid-naïve (no filled opioid prescriptions in the year prior to diagnosis) adults ages 18–64 diagnosed with non-trauma related musculoskeletal pain between January 1, 2008 and December 31, 2014 and who remained continuously enrolled for the year before and after the initial diagnosis. Since musculoskeletal pain can have varying levels of severity, we restricted our analysis to patients with pain severe enough to result in a second outpatient visit or emergency room visit for musculoskeletal pain within 30 days of the initial diagnosis date.(2) We excluded 6,036 patients with missing opioid data and 100,138 patients with conditions that could be confused for musculoskeletal low back pain (nepholithiasis, urinary tract infection, osteomyelitis, cholecystitis, osteoporosis, cauda equina syndrome, and osseous defect), resulting in a final sample of 412,021 patients.

Predictors of long‐term opioid use and opioid use disorder among construction workers: Analysis of claims data

“…However, the prevalence of opioid use and opioid use disorder among this construction cohort is much higher than other populations. Moshfegh and George 44 found that the risk of developing long‐term opioid use among opioid‐naïve patients with new musculoskeletal disorders was less than 1%,—far below the 6.3% risk we found among construction workers diagnosed with chronic musculoskeletal disorder and the 2.4% risk among the workers with acute musculoskeletal injuries. Another study 34 showed that 12% of construction workers received chronic prescriptions, suggesting workers seek treatment for ongoing pain.…”

Real-World Evidence in Prescription Medication Use Among U.S. Adults with Neck Pain

“…However, the extent of this decrease was not significant among patients with neck pain [29]. Machado et al pointed out that there have been very few trials aimed at showing the effectiveness of NSAIDs on neck pain [30].…”

“…Earlier studies showed that there was a significant decrease in opioid use by patients with low back, neck, knee, and shoulder pain between 2008 and 2014 in the USA [29].…”

“…Earlier studies showed that there was a significant decrease in opioid use by patients with low back, neck, knee, and shoulder pain between 2008 and 2014 in the USA [ 29 ]. However, the extent of this decrease was not significant among patients with neck pain [ 29 ]. Machado et al pointed out that there have been very few trials aimed at showing the effectiveness of NSAIDs on neck pain [ 30 ].…”

Physical therapy and opioid use for musculoskeletal pain management: competitors or companions?

“… 38 People with newly diagnosed MSK pain who were opioid-naive when seeking care and subsequently received an opioid prescription had increased risk of chronic opioid use (defined as ≥10 prescriptions or ≥120 days supply between 91 and 365 days after the initial diagnosis). 35 The risk of transitioning from opioid-naive to chronic opioid use for newly diagnosed MSK pain was highest for people with low back pain or with multiple areas of pain (eg, knee and low back pain). 35 Reliance on opioid medication for MSK pain management has led to calls for a shift to providing care models that support nonpharmacologic therapies.…”