Chronic overlapping pain conditions and long-term opioid treatment

• Published in: The American journal of managed care 2023-05, Vol.29 (5), p.233-239
• Main Authors: Ukhanova, Maria, Voss, Robert W, Marino, Miguel, Huguet, Nathalie, Bailey, Steffani R, Hartung, Daniel M, O'Malley, Jean, Chamine, Irina, Muench, John
• Format: Article
• Language: English
• Subjects: Analgesics; Analgesics, Opioid - therapeutic use; Back pain; Chronic Disease; Chronic illnesses; Chronic pain; Chronic Pain - drug therapy; Community health services; Electronic health records; Fibromyalgia; Health facilities; Humans; Indigent care; Irritable bowel syndrome; Low income groups; Medical research; Medicine, Experimental; Mental disorders; Mental health; Methadone; Migraine; Narcotics; Pain management; Patients; Practice Patterns, Physicians; Prescription writing; Primary care; Retrospective Studies; United States; Variables
• ISSN: 1088-0224; 1936-2692; 1936-2692
• DOI: 10.37765/ajmc.2023.89356

One in 5 people in the United States lives with chronic pain. Many patients with chronic pain experience a subset of specific co-occurring pain conditions that may share a common pain mechanism and that have been designated as chronic overlapping pain conditions (COPCs). Little is known about chronic opioid prescribing patterns among patients with COPCs in primary care settings, especially among socioeconomically vulnerable patients. This study aims to evaluate opioid prescribing among patients with COPCs in US community health centers and to identify individual COPCs and their combinations that are associated with long-term opioid treatment (LOT). Retrospective cohort study. We conducted analyses of more than 1 million patients 18 years and older based on electronic health record data from 449 US community health centers across 17 states between January 1, 2009, and December 31, 2018. Logistic regression models were used to assess the relationship between COPCs and LOT. Individuals with COPCs were prescribed LOT 4 times more often than individuals without a COPC (16.9% vs 4.0%). The presence of chronic low back pain, migraine headache, fibromyalgia, or irritable bowel syndrome combined with any of the other COPCs increased the odds of LOT prescribing compared with the presence of a single COPC. Although LOT prescribing has declined over time, it remains relatively high among patients with certain COPCs and for those with multiple COPCs. These study findings suggest target populations for future interventions to manage chronic pain among socioeconomically vulnerable patients.