Ambulatory Diagnosis and Treatment of Nonmalignant Pain in the United States, 2000–2010

Dados Bibliográficos

ID9101021
AutoresMatthew Daubresse (Johns Hopkins University, autor correspondente), Hsien-Yen Chang, Hsien‐Yen Chang (0000-0002-7997-4822, Johns Hopkins University), Yuping Yu (Johns Hopkins University), S Viswanathan (0000-0002-6665-1338, Johns Hopkins University, autor correspondente), Nilay D Shah (0000-0002-8597-3447, Mayo Clinic in Florida), Randall S Stafford (0000-0003-1805-1271, Stanford University), Stefan P Kruszewski, Stefan Kruszewski (0000-0002-8050-6946, Johns Hopkins University), G Caleb Alexander (0000-0002-5622-2986, Johns Hopkins University, autor correspondente)
Ano2013
Volume51
Fascículo10
Páginas870-878
Data de publicação2013-10-01
Peer ReviewedSim
Open AccessNão
TipoARTICLE
PeriódicoMedical Care (JOURNAL)
Identificadores do periódicoISSN: 0025-7079 • E-ISSN: 1537-1948
EditoraOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0b013e3182a95d86
PMID24025657
PMCIDPMC3845222
OpenAlexW2080251825
IdiomaEN
Citações recebidas15
Referências citadas10

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

Ambulatory · Ambulatory care · Context (archaeology) · Cross-sectional study · Health care · Medical prescription · Opioid · Physical therapy · Emergency Medicine · Internal Medicine · Medicine · Musculoskeletal pain and rehabilitation · Opioid Use Disorder Treatment · Pain Management and Opioid Use