Availability of alternative pain treatment decreased opioid use

The likelihood that opioid treatment for common neurological conditions was initiated appeared to decrease with greater access to neurologists or other specialists who offered alternative pain treatment.

Researchers presented these findings at the American Neurological Association annual meeting.

“Despite limited evidence of long-term opioid efficacy in the management of these conditions, studies have shown that opioid treatment is quite common,” Chun Chieh Lin, PhD, MBA, assistant research scientist in the department of neurology at the University of Michigan Medical School, said during a virtual presentation. “Previous studies have looked into factors associated with opioid initiation but have [not evaluated] providers’ roles.”

In the current study, Lin and colleagues sought to investigate opioid initiation trends among patients with new diagnoses of neuropathy, headache and low back pain over time. They also aimed to pinpoint factors linked to opioid initiation among opioid-naive adults with new neurologic diagnoses. They analyzed statistics from 2008 to 2018 Medicare data for patients aged 18 or older with incident neuropathy, headache or low back pain diagnoses between 2010 and 2017.

Primary outcomes included opioid initiation, defined as having the first opioid prescription filled at or after the patient’s diagnosis date, and disease-related opioid initiation, defined as having the first opioid prescription filled within 7 days of a disease-specific visit claim. The other primary outcome was chronic opioid use initiation, defined as having at least 10 opioid prescription fulfillments or at least a 120-day opioid supply within 1 year of initiation. Covariates included diagnosing provider specialty, alternative therapies, regional provider density and patient characteristics.

Results showed 20,086 neuropathy, 49,415 headache and 71,347 low back pain diagnoses between 2010 and 2017 without other chronic pain conditions or filled opioid prescriptions within 2 years before the index diagnosis. Fifty-four percent of patients with neuropathy, 54% of patients with headache and 62% of patients with low back pain initiated opioids, with more than one-third of these prescribed by primary care providers. Between 4% and 6% became chronic opioid users within 12 months of initiation. Fewer than one-third of initial opioid prescriptions were less than a 3-day supply. Two percent of patients with neuropathy, 8% of patients with headache and 22% of patients with low back pain initiated disease-linked opioids.

“[These] data can inform policymakers to provide a better support mechanism for providers who have difficulty managing [patients’] pain and [assist] patients in accessing specialists in low-density regions,” Lin said during the presentation.