Treatment of Neck Pain with Opioids in the Primary Care Setting: Trends and Geographic Variation

Abstract

Objective Neck pain is a leading cause of years lived with disability and is often managed with opioid medications in primary care settings, though this is contraindicated by national guidelines. The aim of this study was to determine the prevalence of opioid prescription for neck pain at a primary care visit and to analyze the geographic variation and trends in opioid prescriptions between 2011 and 2017. Methods Using a prescription drug claims database, we identified 591,961 adult patients who presented for neck pain in primary care settings between 2011 and 2017. Patients who had outpatient specialty visits within 1 year before presentation, a concomitant diagnosis of a non-musculoskeletal cause of neck pain, or preexisting chronic opioid use were excluded. Results The mean age of the patients was 45 ± 12 years, and 64% were female. Fifteen percent of patients were prescribed opioids within 30 days of their encounter. Eleven percent of patients were prescribed moderate- to high-dose opioids (>20 morphine milligram equivalents). From 2011–2017, the proportion of both overall opioid prescriptions and moderate- to high-dose prescriptions given to first time presenters to an outpatient clinic for neck pain was highest in Mississippi (20%) and lowest in New Mexico (6%) (P < 0.001). In 2017, the proportion of both overall opioid prescriptions and moderate- to high-dose prescriptions was highest in the Midwest (10.4%) and lowest in the Northeast (4.9%). The proportion of patients with filled opioid prescriptions declined between 2011 (19%) and 2017 (13%) (P < 0.001), and the proportion of patients with moderate- to high-dose prescriptions declined from 2011 (13%) to 2017 (8%) (P < 0.001). first-time presenters of neck pain to an outpatient clinic Conclusions Opioid medication use for neck pain in the primary care setting is significant. Although opioid prescriptions are declining, there remains a need for further standardization in prescription practices.

Prescription trends of opioid and non-opioid controlled prescription adjunctive analgesics prior to and after cervical spinal surgery: a retrospective cohort study

“…Chronic neck pain has been associated with increased opioid prescriptions. 19 Prolonged opioid use, especially in chronic pain, may lead to opioid tolerance, dependence, and addiction. In addition, preoperative opioid use in any type of surgery has been shown to be a significant factor for postoperative use.…”

“…Considering the surgeries were planned ahead of time and not done on an urgent/emergent basis, they were likely performed for conditions of a chronic or refractory nature. Chronic neck pain has been associated with increased opioid prescriptions 19 . Prolonged opioid use, especially in chronic pain, may lead to opioid tolerance, dependence, and addiction.…”

Price elasticity of demand for new and recurring opioid prescriptions

“…Regional differences in opioid prescribing and consumption behavior for musculoskeletal pain have been observed in the United States (Jami et al, 2021; Davison et al, 2020), as have regional differences in non-narcotic treatments for pain, such as physical therapy, non-steroidal anti-inflammatory drugs (NSAIDs), and muscle relaxants (Machlin et al, 2011; Zimbelman et al, 2010). While the underlying reasons for these geographic patterns are unclear, together these studies suggest that preferences for treating pain may broadly track the current geo-cultural alignments in the United States – i.e., the divergence between the “coastal” (northeast and western) states and the central-southern states (Klaus & Romain, 2021).…”

“…Regional differences in opioid prescribing and consumption behavior for musculoskeletal pain have been observed in the United States (Jami et al, 2021;Davison et al, 2020), as have regional differences in non-narcotic treatments for pain, such as physical therapy, non-steroidal antiinflammatory drugs (NSAIDs), and muscle relaxants (Machlin et al, 2011;Zimbelman et al, 2010).…”