Treatment Patterns and Population Characteristics of Nonpharmacological Management of Chronic Pain in the United States’ Medicare Population: A Scoping Review

Abstract

Background and Objectives Clinical practice guidelines recommend noninvasive nonpharmacologic pain therapies; however, reviews that assess the literature pertaining to nonpharmacologic pain management among older adults and people with long-term disabilities who are disproportionately impacted by pain are lacking. This scoping review aimed to systematically map and characterize the existing studies about the receipt of noninvasive, nonpharmacologic pain therapies by Medicare beneficiaries. Research Design and Methods We conducted a literature search in MEDLINE (PubMed), CINAHL (EBSCO), SocINDEX (EBSCO), Cochrane Library, Web of Science citation indices and various sources of gray literature. The initial search was conducted November 2nd, 2021, and updated on March 9, 2022. Two independent reviewers screened titles, abstracts, and full texts for inclusion and extracted the characteristics of the studies, studied populations, and nonpharmacologic pain therapies. Data was summarized using tabular and narrative formats. Results The final review included 33 studies. Of these, 24 were quantitative, 7 were qualitative, and 2 were mixed-methods studies. Of 32 studies that focused on Medicare beneficiaries, 10 did not specify the Medicare type, and all but one of the remaining studies were restricted to fee-for-service enrollees. Back and neck pain and arthritis were the most commonly studied pain types. Chiropractic care (n=19) and physical therapy (n=17) appeared frequently among included studies. The frequency and/or duration of nonpharmacologic treatment was mentioned in 13 studies. Trends in the utilization of nonpharmacologic pain therapies were assessed in 6 studies but none of these studies went beyond 2008. Discussion and Implications This scoping review found that manipulative therapies, mainly chiropractic, have been the most widely studied approaches for nonpharmacologic pain management in the Medicare population. The review also identified the need for future research that updates trend data and addresses contemporary issues such as rising Medicare Advantage enrollment and promulgation of practice guidelines for pain management.

The Impact of Nonpharmacological Interventions on Opioid Use for Chronic Noncancer Pain: A Scoping Review

“…Nineteen studies [49%, 19/39] focused on individuals with chronic low back pain (cLBP), making cLBP the most common location of pain reported, which aligns with the extant literature showing cLBP is the most common reported and disabling conditions [ 4 , 40 , 48 , 57 ]. Similarly, another scoping review on the use of NPIs for U.S. Medicare population characteristics showed that 55% of the studies included in their review reported back pain [ 4 ]. Additionally, similar to the scoping review mentioned above [ 4 ], our scoping review only included two studies on acupuncture [ 30 , 53 ]; however, unlike our scoping review, this article did not examine and report the impact of NPIs on opioid use and pain intensity.…”

“…Similarly, another scoping review on the use of NPIs for U.S. Medicare population characteristics showed that 55% of the studies included in their review reported back pain [ 4 ]. Additionally, similar to the scoping review mentioned above [ 4 ], our scoping review only included two studies on acupuncture [ 30 , 53 ]; however, unlike our scoping review, this article did not examine and report the impact of NPIs on opioid use and pain intensity. Demographically, twenty-eight [72%, 28/39] studies reported race and ethnicity characteristics, but only four studies [10%, 4/39] included a sample of >50% underrepresented populations [ 44 , 51 , 65 , 66 ], which aligns with a similar review [ 4 ].…”

“…CNCP is a biopsychological disorder, involving a complex interplay of psychological, social, and biological factors that synergistically contribute to individualized pain experiences, and most often requires a personalized multimodal approach to management [ 2 , 3 ]. Despite clinical guidelines recommending limiting opioids and promoting the use of nonpharmacological interventions (NPIs) as first line therapies for treating CNCP [ 4 , 5 , 6 ], opioid prescriptions are still the most common treatment used for CNCP [ 4 , 7 ]. The U.S. has less than 5% of the world’s population but consumed more than 99% of the world’s hydrocodone and 80% of the world’s oxycodone in 2009, which is more opioid consumption per capita than any other country in the world [ 8 , 9 ].…”

“…Nonpharmacological interventions (NPIs) are broad ranging and can be grouped as oriented towards physical, psychological, or clinical process aspects of care [ 31 ]. NPIs may include acupuncture or neurostimulation, mindfulness-based stress reduction, cognitive behavioral therapy, hypnosis, spirituality, tai chi/qigong, yoga, massage therapy, multidisciplinary rehabilitation, self-management programs, educational programs, devices, digital health technology, and manipulative therapies [ 4 , 32 ]. NPIs may address emotion dysregulation, pain, and reward-processing deficits that often drive opioid use, tolerance, and dependence [ 33 ].…”

Introduction to Special Issue: Translational Research on Pain and Pain Management in Later Life

“… Choudry et al (2023) conducted a scoping review to characterize the types of studies that have examined nonpharmacologic pain treatments in the Medicare population with a specific focus on identifying and analyzing both qualitative as well as nonexperimental quantitative studies. The investigators conducted a comprehensive search of multiple databases over a 20-year (1992–2022) period and identified 33 studies for analysis.…”