Nonopioid management common among adults with chronic pain, yet opioid use persists

Many U.S. adults reported using a variety of nonopioid techniques to manage their chronic pain, but some said they still rely on opioids, according to survey findings published in JAMA Network Open.

The survey further showed that psychological therapies were utilized the least often in managing chronic pain.

“Nonpharmacologic and nonopioid pharmacologic therapies are preferred treatments for chronic pain, and it is encouraging to note that most adults with chronic pain use a combination of various nonopioid modalities for treatment,” Cornelius B. Groenewald, MB, ChP, an associate professor of anesthesiology and pain medicine at the University of Washington School of Medicine and a pediatric anesthesiologist at Seattle Children’s Hospital, and colleagues wrote.

Groenewald and colleagues assessed the pain management techniques used by 31,916 participants who responded to the 2019 National Health Interview Survey on chronic pain. Among the participants, 64% were women, 68.5% were non-Hispanic white, 13% were Hispanic and 10.9% were non-Hispanic African American. Most respondents were aged 18 to 64 years (70.9%), while the remaining were aged 65 years or older. The researchers asked participants to report their use of different pain management techniques during the previous 3 months.

Overall, 54.7% (95% CI, 53.1-56.3) of participants with chronic pain used nonopioid pain management, while 10.7% (95% CI, 9.9-11.6) used both opioids and nonopioid techniques. Groenewald and colleagues reported that 4.4% (95% CI, 3.8-5.1) of participants only used opioids and 30.2% did not use any pain management techniques.

Complementary therapies were the most common nonopioid pain management technique, used by 35.4% (95% CI, 33.9-36.9) of adults. Physical, occupational or rehabilitative therapy was the second most common technique, used by 18.8% (95% CI, 17.8-19.9) of adults, according to the researchers. Only 3.8% (95% CI, 3.3-4.4) of adults with chronic pain used psychological or psychotherapeutic interventions.

Other techniques reported by the participants were self-management programs (5.1%; 95% CI, 4.5-5.8) and chronic pain peer support groups (1.8%; 95% CI, 1.5-2.3). Meanwhile, 39.1% (95% CI, 37.3-40.9) of adults with chronic pain reported using other pain techniques not specified in the data set, according to Groenewald and colleagues.

Opioid use for chronic pain was more common among adults aged 45 to 64 years (19.3%; 95% CI, 17.6-21.2) compared with adults aged 18 to 44 years (8.4%; 95% CI, 6.8-10.3), women (16.9%; 95% CI, 15.5-18.5) compared with men (13.1%; 95% CI, 11.7-14.7) and insured adults (16.3%; 95% CI, 15.2-17.4%) compared with those uninsured (5.8%; 95% CI, 3.9-8.4). However, the researchers reported that opioid use was less common among those with an annual income of at least $100,000 (8.7%; 95% CI, 7.2-10.5) compared with adults with an annual income of less than $35,000 (19.8%; 95% CI, 18.1-21.5).

“Improved understanding of effective nonopioid pain management techniques is needed to reduce the reliance on opioids for chronic pain,” Groenewald and colleagues wrote.