PubMed: Inequitable Access to Interventional Pain Treatments

[drusso]

Opioid use and social disadvantage in patients with chronic musculoskeletal pain​

Abby L Cheng 1, Brian K Brady 2, Ethan C Bradley 3, Ryan P Calfee 4, Lisa M Klesges 5, Graham A Colditz 5, Heidi Prather 1
Affiliations expand

• PMID: 33773068
• DOI: 10.1002/pmrj.12596

Abstract​

Background: Historically, marginalized patients were prescribed less opioid medication than affluent, white patients. However, because of persistent differential access to non-opioid pain treatments, this direction of disparity in opioid prescribing may have reversed.
Objective: To compare social disadvantage and health in patients with chronic pain who were managed with vs without chronic opioid therapy. We hypothesized that patients routinely prescribed opioids would be more likely to live in socially disadvantaged communities and report worse health.
Design: Cross-sectional analysis of a retrospective cohort defined from medical records from 2000-2019.
Setting: Single tertiary safety net medical center.
Patients: Adult patients with chronic musculoskeletal pain who were managed longitudinally by a physiatric group practice from at least 2011 to 2015 (n = 1173), sub-grouped by chronic (≥4 years) adherent opioid usage (n = 356) vs no chronic opioid usage (n = 817).
Intervention: Not applicable.
Main outcome measures: The primary outcome was the unadjusted between-group difference in social disadvantage, defined by living in the worst national quartile of the Area Deprivation Index (ADI). An adjusted effect size was also calculated using logistic regression, with age, sex, race, and Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference and Physical Function scores as covariates. Secondary outcomes included adjusted differences in health by chronic opioid use (measured by PROMIS).
Results: Patients managed with chronic opioid therapy were more likely to live in a zip code within the most socially disadvantaged national quartile (34.9% [95%CI 29.9%-39.9%] vs 24.9% [21.9%-28.0%], P < .001), and social disadvantage was independently associated with chronic opioid use (OR 1.01 per ADI percentile [1.01-1.02]). Opioid use was also associated with meaningfully worse PROMIS Depression (3.8 points [2.4-5.1]), Anxiety (3.0 [1.4-4.5]), and Pain Interference (2.6 [1.7-3.5]) scores.
Conclusions: Patients prescribed chronic opioid treatment were more likely to live in socially disadvantaged neighborhoods, and chronic opioid use was independently associated with worse behavioral health. Improving access to multidisciplinary, non-opioid treatments for chronic pain may be key to successfully overcoming the opioid crisis. This article is protected by copyright. All rights reserved.
Keywords: Anxiety; Chronic pain; Depression; Musculoskeletal; Opioids; Pain management; Sociocultural.
This article is protected by copyright. All rights reserved.

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[Orin]

This is partially a US issue as failing at life leads to not having money/access to insurance leads to cheaper options like Norco+Methadone rather than the aromatherapy clinic with acupuncture and caviar for your pain.

If you give a mouse real health insurance though, it'll probably get better treatment.

 

[Ducttape]

this is what happens with pain care is incentivized purely through financial means.

make multidisciplinary care available to socially disadvantaged, but equally as important is to make it financially beneficial for doctors to take care of these patients.

 

[lobelsteve]

A wise young man once said Pain should be the first to go single payor and we would all get salary.
Care would be based on disease. All Rx's and procedures get done by pain. If you fail the system you get locked out.
Both patients and docs.