Nonpharmacologic Treatments Surpass Opioid Treatment for Patients with Chronic, Nonsurgical Pain

Updated prescribing guidelines issued in 2014 and 2016 may explain lower use of opioids by 11.7% among patients with chronic, nonsurgical pain.

More patients with chronic, nonsurgical pain turned to nonpharmacologic clinicians in the past 10 years, according to a study published in JAMA Network Open. Chiropractic treatment increased the most among nonpharmacologic treatment types, but acupuncture and massage therapy were the least prevalent.

For the primary endpoint, researchers examined the association between calendar year (2011-2019) and mutually exclusive pain treatments. The secondary endpoint examined the prevalence of nonpharmacologic treatments—both endpoint analyses were stratified by pain type.

“Between 2011 and 2019, the use of nonpharmacologic treatments increased while neither the use of opioids nor nonpharmacologic therapy decreased,” the study authors wrote.

Between 2016 and 2019, the study also found a large increase in nonpharmacologic treatments. This may be a response to updated CDC guidelines from 2016, which suggested lowering opioid prescriptions for chronic pain conditions.

In 2010, 19% of US adults were affected by chronic pain—this rate was estimated to increase within the next decade. Annual pain expenses can include health care costs, which may range between $261 and $300 billion, and lost productivity, which can cost upwards of $355 billion.

Previous studies have found that low-risk and non-pharmacological treatments may reduce pain and improve function. These interventions can include acupuncture, going to a chiropractor, massage therapy, occupational therapy, and physical therapy.

These treatments could also have fewer adverse effects (AEs) than opioids, which are “associated with a heightened risk of [AEs] including falls, misuse or diversion, preventable hospital admissions, and overdose mortality,” the study authors wrote.

The study authors sought to describe annual trends in mutually exclusive use of prescription opioids, non-pharmacologic treatments, both, or neither, use of various nonpharmacologic treatments, relationship between calendar year and treatment type, and annual treatment use based on pain severity.

The researchers included 46,420 respondents in a serial cross-sectional analysis, in which they estimated the use of outpatient services among adults with chronic or surgical pain (and cancer-free).

According to the results, only patients with chronic, nonsurgical pain used more nonpharmacologic treatments than opioids. Specifically, the use of a chiropractor increased to 8.4% in 2012—and by 2019, 25.6% of all chronic pain participants were treated by a chiropractor.

“Among cancer-free adults with pain, the annual prevalence of nonpharmacologic pain treatments increased and the prevalent use of neither opioids nor nonpharmacologic therapy decreased for both chronic and surgical pain cohorts,” the study authors wrote.

Study limitations include the findings not being generalizable to all populations. Additionally, researchers did not include pharmacologic opioid substitutes. Instead, they combined all nonpharmacologic treatments into a single category and only identified chronic pain using the Agency for Healthcare Research and Quality.

“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,” the study authors wrote.

Reference

Pritchard, Kevin. Baillargeon, Jacques, Lee, Wei-Chen, et al. Trends in the Use of Opioids vs Nonpharmacologic Treatments in Adults With Pain, 2011-2019. JAMA Netw Open. 2022;5(11):e2240612. doi:10.1001/jamanetworkopen.2022.40612