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Patients taking opioids for musculoskeletal conditions ‘highly satisfied’ with care
Patients who took opioids and had a self-reported diagnosis of chronic joint arthritis or pain, or whose treatment included a specific ICD-9-CM code for a musculoskeletal condition, were more likely to be “highly satisfied” with their care, according to findings recently published in Annals of Family Medicine.
“There is an important mechanistic link between how health systems get paid and self-reported patient satisfaction,” Brian D. Sites, MD, MS, Geisel School of Medicine at Dartmouth, told Healio Family Medicine. “However, what happens if optimizing patient satisfaction does not correlate with improvements in patient safety, health, and outcomes? This study establishes the connection between opioid prescribing and satisfaction in the context of the American crisis of the overprescribing of opioids.”
Researchers conducted a cross-sectional study using nationally representative data of 19,566 patients with musculoskeletal conditions, determining their opioid use and utilizing five areas to ascertain satisfaction with care: how the health care professional rated on an ordinal scale of zero to 10; how frequently in the past year the health care professionals spent enough time with patients, demonstrated respect to the patient, described things in a way that was simple to comprehend and listened carefully.
Sites and colleagues found that 2,564 of the patients received one or more opioid prescriptions in two 6-month time intervals. The others were considered limited or nonusers. Despite the majority of patients reporting satisfaction with their care,, SF-12 physical component summary score for opioid users was 33.3, compared to 46 for non-users, mean SF-12 mental component summary score was 44.4, compared to 49.9 for non-users and 50.5% of all opioid users rated their overall health as “poor” or “fair,”compared to just 19.7% of non users. Opioid users also had a higher self-reported pain level, with 75.5% reporting moderate to extreme pain compared to 30.5% of non-users.
“Our findings indicate ... that patients with musculoskeletal conditions taking opioids have more pain and worse health and disability than those taking no or limited amounts of these drugs,” Sites and colleagues wrote, “The lack of an association between opioid prescribing and improvements in pain on a population health level has been highlighted by the CDC.”
Given the side effects associated with opioid use, including sedation, behavioral issues, sexual dysfunction, constipation and itching, researchers had expected lower opioid prescribing to be associated with higher satisfaction, but among persistent opioid users, moderate and heavy users were 55% and 41% more likely, respectively, to report the highest levels of satisfaction.
Researchers also reported that vs. nonusers, opioid users were more likely to report high satisfaction with care (OR = 1.32; 95% CI, 1.18-1.49). Based on level of use, a stronger link was observed with the use of 10 or more opioid prescriptions (OR = 1.43; 95% CI, 1.2-1.7) and the use of five to nine moderate opioid use (OR = 1.55; 95% CI, 1.29-1.86).
Given the ongoing opioid crisis, the findings suggest that a shift in thinking on how patient satisfaction affects decision-making with regard to pain management is needed.
“The key from our perspective is that opioid prescribing needs to move into the realm of goal-directed therapy. I cannot stress this enough,” Sites said. “These therapy goals need to be linked to improvements in activities of daily living, reductions in disability metrics, and better health. Physicians and patients should set objective goals of therapy upon which they can judge the appropriateness of continuing therapy. It should be made clear to patients that health and disability may worsen based on the opioid therapy.”
“[In addition,] patient satisfaction can still be optimized by the use of multimodal and polypharmacy approaches to analgesia that do not solely rely on opioid prescribing. Cognitive behavioral therapy to minimize pain [also] represents a huge opportunity to help patients through difficult situations,” he added.
Sites suggested next steps for this line of research.
“Data, including ours, is usually cross-sectional in nature, so we do not know whether the opioid users actually experienced improvement or if their conditions would have been worse had the opioids not been prescribed,” he said. “However, the finding of worse health among opioid users must be clarified in future studies to understand whether meaningful changes, beyond patient satisfaction, are actually occurring. Given that so many lives are being destroyed by prescription opioids, the research community must act fast.”
“We [also] desperately need a population-based longitudinal study examining the health benefits for the initiation of opioid therapy for non-cancer related conditions. Only then can we determine if risks are commensurate with benefits on a large population-based level,” Sites added. – by Janel Miller
Disclosure: The authors report no relevant financial disclosures.