Ambulatory diagnosis and treatment of nonmalignant pain in the United States, 2000-2010
- PMID: 24025657
- PMCID: PMC3845222
- DOI: 10.1097/MLR.0b013e3182a95d86
Ambulatory diagnosis and treatment of nonmalignant pain in the United States, 2000-2010
Abstract
Background: Escalating rates of prescription opioid use and abuse have occurred in the context of efforts to improve the treatment of nonmalignant pain.
Objective: The aim of the study was to characterize the diagnosis and management of nonmalignant pain in ambulatory, office-based settings in the United States between 2000 and 2010.
Design, setting, and participants: Serial cross-sectional and multivariate regression analyses of the National Ambulatory Medical Care Survey (NAMCS), a nationally representative audit of office-based physician visits, were conducted.
Measures: (1) Annual visit volume among adults with primary pain symptom or diagnosis; (2) receipt of any pain treatment; and (3) receipt of prescription opioid or nonopioid pharmacologic therapy in visits for new musculoskeletal pain.
Results: Primary symptoms or diagnoses of pain consistently represented one-fifth of visits, varying little from 2000 to 2010. Among all pain visits, opioid prescribing nearly doubled from 11.3% to 19.6%, whereas nonopioid analgesic prescribing remained unchanged (26%-29% of visits). One-half of new musculoskeletal pain visits resulted in pharmacologic treatment, although the prescribing of nonopioid pharmacotherapies decreased from 38% of visits (2000) to 29% of visits (2010). After adjusting for potentially confounding covariates, few patient, physician, or practice characteristics were associated with a prescription opioid rather than a nonopioid analgesic for new musculoskeletal pain, and increases in opioid prescribing generally occurred nonselectively over time.
Conclusions: Increased opioid prescribing has not been accompanied by similar increases in nonopioid analgesics or the proportion of ambulatory pain patients receiving pharmacologic treatment. Clinical alternatives to prescription opioids may be underutilized as a means of treating ambulatory nonmalignant pain.
Figures
![Figure 1](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/3845222/bin/nihms525493f1.gif)
![Figure 2](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/3845222/bin/nihms525493f2.gif)
Similar articles
-
Cost of pain medication to treat adult patients with nonmalignant chronic pain in the United States.J Manag Care Spec Pharm. 2014 Sep;20(9):921-8. doi: 10.18553/jmcp.2014.20.9.921. J Manag Care Spec Pharm. 2014. PMID: 25166291 Free PMC article.
-
Rising opioid prescribing in adult U.S. emergency department visits: 2001-2010.Acad Emerg Med. 2014 Mar;21(3):236-43. doi: 10.1111/acem.12328. Acad Emerg Med. 2014. PMID: 24628748
-
National Estimates of Chronic Musculoskeletal Pain and Its Treatment in Children, Adolescents, and Young Adults in the United States: Data From the 2007-2015 National Ambulatory Medical Care Survey.J Pediatr. 2021 Jun;233:212-219.e1. doi: 10.1016/j.jpeds.2021.01.055. Epub 2021 Jan 29. J Pediatr. 2021. PMID: 33524388
-
Trends in Prescription Analgesic Use Among Adults With Musculoskeletal Conditions in the United States, 1999-2016.JAMA Netw Open. 2019 Dec 2;2(12):e1917228. doi: 10.1001/jamanetworkopen.2019.17228. JAMA Netw Open. 2019. PMID: 31825504 Free PMC article.
-
Attempts to Limit Opioid Prescribing in Critically Ill Patients: Not So Easy, Not So Fast.Ann Pharmacother. 2019 Jul;53(7):716-725. doi: 10.1177/1060028018824724. Epub 2019 Jan 13. Ann Pharmacother. 2019. PMID: 30638027 Review.
Cited by
-
Trends in Israeli community-based opioid prescribing, 2010-2020, an observational study of the country's largest HMO.Isr J Health Policy Res. 2023 Nov 16;12(1):34. doi: 10.1186/s13584-023-00581-w. Isr J Health Policy Res. 2023. PMID: 37974249 Free PMC article.
-
Opioids for acute and chronic pain when receiving psychiatric medications.PLoS One. 2023 Sep 26;18(9):e0286179. doi: 10.1371/journal.pone.0286179. eCollection 2023. PLoS One. 2023. PMID: 37751410 Free PMC article.
-
Racial and Ethnic Disparities in Opioid Prescriptions for Patients with Abdominal Pain: Analysis of the National Ambulatory Medical Care Survey.J Clin Med. 2023 Jul 31;12(15):5030. doi: 10.3390/jcm12155030. J Clin Med. 2023. PMID: 37568432 Free PMC article.
-
The Effects of Intraoperative Remifentanil Infusion on Postoperative Opioid Consumption in Patients Who Underwent Total Knee Arthroplasty with Femoral Nerve Block.J Clin Med. 2023 Jul 28;12(15):4975. doi: 10.3390/jcm12154975. J Clin Med. 2023. PMID: 37568377 Free PMC article.
-
Morphine Equianalgesic Dose Chart in the Emergency Department.J Educ Teach Emerg Med. 2022 Jul 15;7(3):L1-L20. doi: 10.21980/J8RD29. eCollection 2022 Jul. J Educ Teach Emerg Med. 2022. PMID: 37465775 Free PMC article.
References
-
- IOM (Institute of Medicine) Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press; 2011. - PubMed
-
- Fox CD, Berger D, Fine PG, et al. A position statement from the American Pain Society. Glenview, IL: American Pain Society; 2000. Pain assessment and treatment in the managed care environment. - PubMed
-
- McCarberg BH. Pain management in primary care: strategies to mitigate opioid misuse, abuse, and diversion. Postgrad Med. 2011;123:119–30. - PubMed
-
- U.S. Agency for Health Care Policy and Research. Acute Pain Management: Operative or Medical Procedures and Trauma. (AHCPR Pub. No. 92-0032) Rockville, MD: U.S. Department of Health and Human Services; 1992.
-
- American Pain Society. Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain. Vol. 4. Glenview, IL: American Pain Society; 1999.
Publication types
MeSH terms
Substances
Grants and funding
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical