Ambulatory diagnosis and treatment of nonmalignant pain in the united states, 2000-2010

Matthew Daubresse, Hsien-Yen Chang, Yuping Yu, Shilpa Viswanathan, Nilay D. Shah, Randall S. Stafford, Stefan P. Kruszewski, George Caleb Alexander

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)870-878
Number of pages9
JournalMedical Care
Volume51
Issue number10
DOIs
StatePublished - Oct 2013

Fingerprint

Opioid Analgesics
Pain
Non-Narcotic Analgesics
Musculoskeletal Pain
Prescriptions
Therapeutics
Health Care Surveys
Physicians' Offices
Pain Management
Multivariate Analysis
Regression Analysis
Physicians
Drug Therapy

Keywords

  • ambulatory
  • analgesic
  • diagnosis
  • nonopioid
  • opioid
  • pain
  • treatment

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Ambulatory diagnosis and treatment of nonmalignant pain in the united states, 2000-2010. / Daubresse, Matthew; Chang, Hsien-Yen; Yu, Yuping; Viswanathan, Shilpa; Shah, Nilay D.; Stafford, Randall S.; Kruszewski, Stefan P.; Alexander, George Caleb.

In: Medical Care, Vol. 51, No. 10, 10.2013, p. 870-878.

Research output: Contribution to journalArticle

Daubresse, M, Chang, H-Y, Yu, Y, Viswanathan, S, Shah, ND, Stafford, RS, Kruszewski, SP & Alexander, GC 2013, 'Ambulatory diagnosis and treatment of nonmalignant pain in the united states, 2000-2010', Medical Care, vol. 51, no. 10, pp. 870-878. https://doi.org/10.1097/MLR.0b013e3182a95d86
Daubresse, Matthew ; Chang, Hsien-Yen ; Yu, Yuping ; Viswanathan, Shilpa ; Shah, Nilay D. ; Stafford, Randall S. ; Kruszewski, Stefan P. ; Alexander, George Caleb. / Ambulatory diagnosis and treatment of nonmalignant pain in the united states, 2000-2010. In: Medical Care. 2013 ; Vol. 51, No. 10. pp. 870-878.
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AB - 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.

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