Risk Factors Associated With Chronic Opioid Use in Musculoskeletal Pain

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Musculoskeletal pain at multiple sites and use of opioids within 3 months of diagnosis were associated with a higher risk for chronic opioid use.
Musculoskeletal pain at multiple sites and use of opioids within 3 months of diagnosis were associated with a higher risk for chronic opioid use.

The chronic use of opioids was found to be low in individuals with musculoskeletal pain, and to have decreased from 2008 to 2014, according to a study recently published in the Annals of Internal Medicine. Musculoskeletal pain at multiple sites and use of opioids within 3 months of diagnosis were associated with a higher risk for chronic opioid use.

Data for this study were collected from the IBM MarketScan database and comprised 412,021 opioid-naive individuals aged 18 to 64 years (average, 45 years) who were treated for a musculoskeletal pain diagnosed between January 2008 and December 2014. Inclusion criteria included treatment within 1 month in emergency or second outpatient departments (to establish a threshold severity of pain), complete opioid data, and a lack of conditions frequently misidentified as musculoskeletal pain in the lower back.

The annual unadjusted risk for chronic opioid use was 1.5% for pain at multiple sites, 1.4% for low back pain, 0.43% for neck pain, and 0.3% for both knee and shoulder pain. There was a reduction in the risk for chronic opioid use in individuals with multiple-site pain, low-back pain, and knee pain over the study period (P <.001), with an overall risk for chronic opioid use of 0.31% (95% CI, 0.29-0.33%). Anatomical region was found to be a risk factor for chronic opioid use, with multiple site pain and low back pain associated with the highest risks. Individuals prescribed opioids within 90 days of diagnosis had an absolute adjusted risk for chronic opioid use of 1.9% (95% CI, 1.8-2.0%), compared with 0.15% (95% CI, 0.14-0.16%) for patients not prescribed opioids within the first 90 days.

Limitations to this study include the sole inclusion of privately insured individuals, and the lack of recording of nonprescribed opioid use.

“Risk for chronic opioid use among patients with musculoskeletal pain has decreased and point to some measures (such as avoiding opioid use soon after diagnosis) to further reduce this risk, particularly among those with the risk factors identified here (for example, low back and multiple-site pain). Patients with these risk factors should be closely followed and may benefit from involvement of a nonpharmacologic provider, such as a physical therapist or chiropractor,” concluded the study authors.

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Reference

Moshfegh J, George SZ, Sun E. Risk and risk factors for chronic opioid use among opioid-naive patients with newly diagnosed musculoskeletal pain in the neck, shoulder, knee, or low back [published online December 18, 2018]. Ann Intern Med. doi: 10.7326/M18-2261

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