Opioid use has fallen 15% annually since 2014 in autoimmune rheumatic disease
Click Here to Manage Email Alerts
Key takeaways:
- Non-opioid pain management, such as physical therapy, has increased or stabilized among rheumatic disease patients since 2007.
- Opioid usage has fallen 15% each year among those patients since 2014.
Opioid use in patients with autoimmune rheumatic disease has decreased 15% annually since 2014, while use of non-opioid options for pain management has either increased or stabilized, according to data published in The Lancet Rheumatology.
“In the general population, the use of pain-related modalities has changed in recent years,” Titilola Falasinnu, PhD, an assistant professor of medicine at the Stanford University School of Medicine, and colleagues wrote. “The incidence of patients with chronic pain receiving long-term opioid prescriptions decreased from 24% in 2010 to 10% in 2015.
“However, little is known about recent changes in the use of alternative chronic pain treatment modalities in people with autoimmune rheumatic diseases,” they added. “Such knowledge will be fundamental for updating chronic pain treatment guidelines in rheumatology.”
To assess trends in the use of opioids, antidepressants, NSAIDs and other therapies for pain management in autoimmune rheumatic disease, Falasinnu and colleagues analyzed data on 141,962 patients included in the Merative MarketScan Research Databases from 2007 to 2021. The analysis included 10,927 patients with ankylosing spondylitis, 21,438 with psoriatic arthritis, 71,393 with rheumatoid arthritis, 16,718 with Sjögren’s syndrome, 18,018 with systemic lupus erythematosus and 3,468 with systemic sclerosis.
The researchers used logistic regression to examine annual opioid use trends — the primary outcome — while secondary outcomes included trends in the use of anticonvulsants, antidepressants, skeletal muscle relaxants, NSAIDs, topical pain medications and physical or occupational therapy. The non-opioid modalities were chosen “because of evidence for their use in pain management in the general population,” Falasinnu and colleagues wrote.
According to the researchers, opioid use incidence increased by 4% each year (adjusted OR = 1.04; 95% CI, 1.03-1.04) until 2014, when it began decreasing by 15% annually (adjusted OR = 0.85; 95% CI, 0.84-0.86). Meanwhile, non-opioid pain management options “increased or stabilized,” the researchers wrote.
Before 2014, the incidence of physical therapy use increased annually by 5% (adjusted OR = 1.05; 95% CI, 1.04-1.06), as did anticonvulsant use by 7% (adjusted OR = 1.07; 95% CI, 1.07-1.08) and NSAIDs by 2% (adjusted OR = 1.02; 95% CI, 1.02-1.03). After 2014, physical therapy decreased slightly by 1% annually (adjusted OR = 0.99; 95% CI, 0.98-1), anticonvulsant use showed no significant changes (adjusted OR = 1; 95% CI, 0.99-1), and NSAIDs decreased annually by 5% (adjusted OR = 0.95; 95% CI, 0.95-0.96).
“Our administrative claims study highlights a shift towards increased use of non-opioid
pain management modalities and a decline in opioid and NSAID prescriptions among patients with newly diagnosed autoimmune rheumatic diseases in the USA, reflecting changes possibly influenced by policy shifts and updated clinical guidelines,” Falasinnu and colleagues wrote. “However, further research is warranted to assess the long-term effect of these trends on patient outcomes and to address gaps in pain management strategies for less prevalent conditions such as Sjögren’s syndrome and systemic sclerosis.”
Perspective
Back to Top
David A. McLain, MD, MACR, FACP, FRCP
There is a history of trends in medicine that change what is considered the “norm” or “community standard.” These changes are usually based on research, data analysis, new drugs, or new surgical or diagnostic procedures. Sometimes, they are based on fads, group think and promotion.
The present analysis of trends in rheumatology practice found a decrease in the use of opioid analgesics and NSAIDs from 2007 to 2021.
In the 20th century, pain management became predominately pharmacologic. Studies seemed to show that opioids for non-cancer pain were not addictive. There was also a perception in the 1990s that pain was being under-treated. The American Pain Society introduced pain as the fifth vital sign and the Joint Commission overemphasized pain control as a quantifiable measure in certifying hospitals.
This led to an increase in the use of opioids for both cancer and non-cancer pain. From 1990 until 1995, there was an increase of 2 to 3 million opioid prescriptions yearly. Between 1999 and 2016, more than 630,000 persons in the United States died from drug overdoses, with most of these drug-related deaths due to opioids prescribed for pain.
More recently, opioid overdoses have been primarily related to illicit opioids, such as heroin and illicitly manufactured fentanyl. Recent studies, like the present one, have shown that prescriptions for opioids have fallen substantially (eg, 23% for Medicaid patients from 2016-2019).
If opioids are not an acceptable treatment, how about NSAIDs? The risks for heart attack and stroke with NSAIDs — either of which can lead to death — were first described in 2005 in the boxed and other warnings included in their prescription drug labels. These warnings were strengthened by the FDA in 2015 due to even stronger data linking them.
Heart attack or stroke can occur as early as the first weeks of using an NSAID. The risk may increase with longer use, appears greater at higher doses. Patients with, or at risk for, heart disease have a greater likelihood of heart attack or stroke following NSAID use. Additionally, patients treated with NSAIDs following a first heart attack are more likely to die in the first year after the heart attack, compared with patients who were not treated with NSAIDs after their first heart attack.
Other increased risks associated with NSAIDs include heart and kidney failure, peptic ulcer disease and liver toxicity. Dangerous drug interactions with NSAIDs may occur when used concomitantly with anticoagulants, diuretics, antihypertensives and hypoglycemic drugs.
It is no surprise that the use of NSAIDs has also decreased as shown in the present study.
Collapse
Read more about
Click Here to Manage Email Alerts