Study Finds Non-Opioid Pain Prescriptions Increased Following 2016 CDC Guideline

The increase in prescriptions for non-opioid pain medications coincided with a significant drop in opioid prescribing over the same period.

The prescribing rate of non-opioid pain medications increased each year following a 2016 guideline from the CDC regarding the prescribing of opioids to patients experiencing chronic pain, according to a new study.

The guideline was intended to help clinicians treat adult patients for chronic pain while considering the risks and benefits of prescribing opioids, as the opioid epidemic continued and more Americans died of opioid-related overdoses. Using insurance claims from more than 15 million patients, investigators analyzed the prescribing rates of non-opioid pain medications, such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs).

According to the study, they found that the likelihood of prescribing a nonopioid pain medication in 2016 were 3% higher than expected, compared to pre-guideline estimates for the same year. That number increased to 8% in 2017 and 9.7% in 2018, which were above and beyond what would be expected based on preexisting trends, according to the investigators.

“These findings suggest that clinicians have been prescribing non-opioid pain medications more frequently since the 2016 guideline was released, and that may mean that they’ve considered opioid therapy only if its expected benefits exceeded the expected risks to the patient,” lead author Jason Goldstick, PhD, said in a press release. “Though many characteristics—such as pain intensity and effectiveness of pain management—are not available in these data, these results may represent an increase in guideline-concordant pain treatment.”

The increase in prescriptions for non-opioid pain medications coincided with a significant drop in opioid prescribing over the same period, consistent with other research showing reductions following the 2016 guideline release. Increases in non-opioid pain medication prescribing were consistent across several patient subgroups, including those with recent opioid exposure and those with anxiety or mood disorders, according to the study.

“The 2016 guideline encouraged caution in prescribing opioids, and it was possible that it could have reduced the use of pain treatments overall,” senior author Amy Bohnert, PhD, MHS, said in the press release. “Our analysis provides an encouraging sign that patients were more often offered other treatments for pain than before the guideline, rather than only being offered opioids less often.”

The changes in prescribing may have also led to a shift toward the use of some nonpharmacologic treatments, including physical therapy and cognitive behavioral therapy, according to the study authors. Additional research is needed on changes in nonpharmacologic pain treatments, as well as undertreatment of pain and patient pain outcomes, to gain a fuller understanding of changes to the pain management landscape following the 2016 guideline.

“Mutimodal and multidisciplinary approaches to pain management that address the biological, psychological, and social characteristics of each person are a critical part of a comprehensive treatment protocol,” the researchers wrote in the study. “Further analysis can help identify the avenues through which pain relief can be optimized.”

Reference

Nonopioid pain prescriptions increased after 2016 CDC guideline, study finds. News release. University of Michigan Health Lab; July 15, 2022. Accessed July 19, 2022. https://labblog.uofmhealth.org/lab-notes/nonopioid-pain-prescriptions-increased-after-2016-cdc-guideline-study-finds