Use of Nonpharmacologic Approaches to Pain Management Has Increased in Recent Years

The use of nonpharmacologic treatment strategies for noncancer-related chronic pain has been increasing in the United States, according to the results of a cross-sectional analysis published in JAMA Network Open.

Investigators from the University of Texas Medical Branch sourced data for this study from the Agency for Healthcare Research and Quality Medical Expenditure Panel Survey-Household Component, which obtains samples from the National Center for Health Statistics’ National Health Interview Survey representative of the US population. For this analysis, adults with noncancer chronic (n=36,777) or surgical (n=9643) pain were evaluated for trends in pain treatment received between 2011 and 2019. A weighting approach was used to balance for cohort differences.

The ages of individuals included in the chronic and surgical pain cohorts ranged from 45 to 64 years (42.2% vs 39.6%), most were White (80.3% and 85.0%), and 70.8% reported having at least 1 comorbidity (eg, hypertension, coronary heart disease, hypercholesterolemia, emphysema, bronchitis, diabetes, arthritis, asthma, or stroke).   

Overall, 58.0% of patients received neither nonpharmacologic nor opioid pain treatment, 20.8% received nonpharmacologic treatment alone, 15.5% received opioid treatment alone, and 5.6% received both nonpharmacologic and opioid treatments.

Among both cohorts, the prevalence of receiving no treatment for pain or opioids alone decreased over time while use of nonpharmacologic treatments increased. Among individuals in the chronic pain group, nonpharmacologic treatment alone was more frequently used than opioids alone.  For individuals in the surgical pain group, nonpharmacologic treatment alone was never as prevalent as opioids alone.

In the weighted analysis, compared with data from 2011, patients treated for chronic pain in 2012 (adjusted odds ratio [aOR], 1.25) and 2014 (aOR, 1.22) were significantly more likely to receive opioids alone; those who were treated in 2018 (aOR, 2.23) and 2019 (aOR, 2.72) were more likely to receive nonpharmacologic treatment alone; those treated from 2013 to 2019 (aOR range, 1.48-1.70) were more likely to receive both opioids and nonpharmacologic approaches; and those receiving treatment in 2013 (aOR, 0.86), 2018 (aOR, 0.46), and 2019 (aOR, 0.43) were less likely to receive opioids or nonpharmacologic treatments.

For surgical pain, compared with data from 2011, receiving treatment in 2019 was associated with increased odds of receiving nonpharmacologic therapy alone (aOR, 1.53), receiving treatment between 2014 and 2019 was associated with increased odds of receiving both opioids and nonpharmacologic treatment (aOR range, 1.32-2.32), and receiving treatment between 2014 and 2019 (except for 2017) was associated with decreased odds of receiving no treatment (aOR range, 0.59-0.80).

Stratified by pain interference, increasing pain severity increased the likelihood of receiving opioids with or without nonpharmacologic treatment and decreased the odds of receiving no treatment or nonpharmacologic approaches alone among patients with chronic pain. The trends in the relationship between pain interference and receipt of opioids, opioids plus nonpharmacologic treatment, and no treatment were similar among individuals in the surgical pain cohort.

The results of this study may not be generalizable for special populations, such as institutionalized individuals, military personnel, or patients with cancer.

These data indicate that over time, the use of nonpharmacologic treatment approaches has increased, surpassing the prevalence of opioid use among individuals with noncancer-related chronic pain. The study authors conclude, “Our study holds broad clinical and policy relevance, including expanding the reimbursement for nonpharmacologic health care professionals and equalizing direct access — without a physician referral — between these professionals in some circumstances.”

This article originally appeared on Clinical Pain Advisor