Chronic Pain Management and Outcomes in Adults With and Without Opioid Use Disorder

有和没有阿片类药物使用障碍的成年人的慢性疼痛管理和结果

• 批准号: 10434917
• 负责人: Patience Moyo Dow
• 金额: $ 7.98万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10434917
• 关键词: Address; Adult; Adverse event; Age; Black race; Categories; Chronic; Clinical Practice Guideline; Data; Development; Diagnosis; Disabled Persons; Dose; Elderly; Emergency department visit; Enrollment; Ethnic Origin; Event; Face; Failure; Future; Goals; Health; Health Insurance; High Prevalence; Hispanic; Hospitalization; Illicit Drugs; Incidence; Individual; Inpatients; Insurance Coverage; Intervention; Knowledge; Lead; Link; Measures; Medical; Medicare; Minority; Morbidity - disease rate; Morphine; Nonpharmacologic Therapy; Not Hispanic or Latino; Opioid; Outcome; Outpatients; Overdose; Pain; Pain management; Patients; Pattern; Persons; Pharmaceutical Preparations; Pharmacy facility; Physical therapy; Policies; Population; Practice Guidelines; Prevalence; Race; Research; Risk; Role; Sampling; Subgroup; Treatment outcome; Visit; acute care; adverse outcome; barrier to care; beneficiary; chronic pain; chronic pain management; chronic pain patient; clinical development; comorbidity; data warehouse; design; effective intervention; ethnic minority; evidence based guidelines; experience; gabapentin; illicit opioid; improved; innovation; insight; marginalized population; milligram; mortality; non-cancer chronic pain; non-drug; non-opioid analgesic; nondrug therapy; off-label use; opioid epidemic; opioid therapy; opioid use; opioid use disorder; overdose death; overdose risk; pain outcome; pregabalin; prescription opioid; primary outcome; public health insurance; racial and ethnic; racial and ethnic disparities; racial minority; secondary analysis; social stigma; substance use; treatment comparison

PROJECT SUMMARY/ABSTRACT Both chronic pain and opioid use disorder (OUD) are linked to opioid-related morbidity and mortality. People with comorbid chronic pain and OUD are vulnerable due to their potential under-treatment of pain and OUD, and elevated risk of adverse outcomes such as transition to illicit drugs and overdose. Despite prominent clinical practice guidelines that emphasize opioid alternatives for pain management, little is known about the use of non- opioid and non-drug pain treatments nationally among chronic pain patients. Even less is known within the context of co-occurring chronic pain and OUD, and racial/ethnic minorities. Using Medicare data, the proposed research aims to: (1) evaluate the relationship between OUD status and type of chronic pain management (prescription opioid, non-opioid medication [e.g., gabapentinoids], or non-drug strategies [e.g., physical therapy), and (2) assess if receipt of non-opioid and non-drug treatments is associated with opioid prescribing and drug- related overdoses and acute care use among patients with and without OUD. Key innovations of the proposed research include its focus on overlapping of chronic pain and OUD, and analysis of newly-available OUD indicators in the Medicare Chronic Condition Data Warehouse. The study will also offer new insight into the use of opioid alternatives and outcomes among disabled and older adults who have a high prevalence of chronic pain, are often prescribed opioids, and have rising OUD and overdose rates. We will analyze a 2016-2018 nationally representative 20% random sample of Medicare beneficiaries using enrollment, inpatient, outpatient, and pharmacy claims data. In Aim 1 the main independent variable is OUD status and the primary outcome is the type of pain treatment received defined as a categorical variable. In a secondary analysis, we will evaluate the intensity of each type of pain treatment as measured by opioid morphine milligram equivalents, and count of prescriptions and visits. In Aim 2, the main independent variable is type of pain treatment and the outcomes are long-term high dose opioid use, drug overdoses, and drug-related hospitalizations and emergency department visits. For each aim, we will assess race and ethnicity as a key potential effect modifier. The expected results are that Black and Hispanic beneficiaries with OUD will be less likely to receive any pain treatment compared to non-Hispanic Whites with or without OUD. We further hypothesize that non-opioid treatment is associated with fewer opioid-related adverse outcomes and lower duration and dose of opioid use. Minorities with OUD will have worse outcomes than Whites. The findings have the potential to identify and help address disparities in chronic pain management by providing evidence to inform the development of future practice guidelines that consider the nuanced challenges faced by marginalized groups such as people with OUD and racial minorities.

项目总结/摘要 慢性疼痛和阿片类药物使用障碍（OUD）都与阿片类药物相关的发病率和死亡率有关。人 慢性疼痛和OUD共病是脆弱的，因为它们可能对疼痛和OUD治疗不足， 不良后果的风险增加，如过渡到非法药物和过量。尽管突出的临床 实践指南强调阿片类药物替代品用于疼痛管理，对非阿片类药物的使用知之甚少， 阿片类药物和非药物疼痛治疗全国慢性疼痛患者。更少的是知道在 同时发生慢性疼痛和OUD的背景，以及种族/少数民族。使用医疗保险数据， 本研究旨在：（1）评估OUD状态与慢性疼痛管理类型之间的关系 （处方阿片类药物、非阿片类药物[例如，加巴喷丁类化合物]，或非药物策略[例如，物理治疗）， 和（2）评估接受非阿片类药物和非药物治疗是否与阿片类药物处方和药物相关- OUD患者和非OUD患者的相关药物过量和急性护理使用。拟议战略的主要创新 研究重点包括慢性疼痛和OUD的重叠，以及新的OUD分析 医疗保险慢性疾病数据仓库中的指标。这项研究还将提供新的见解， 阿片类药物替代品和结果的残疾人和老年人谁有高流行率的慢性 疼痛，通常是处方阿片类药物，并有上升的OUD和过量率。我们将分析2016-2018年 具有全国代表性的20%随机抽样的医疗保险受益人，使用登记，住院，门诊， 和药房索赔数据。在目标1中，主要自变量是OUD状态，主要结局是 接受的疼痛治疗类型定义为分类变量。在二次分析中，我们将评估 通过阿片类吗啡毫克当量测量的每种类型的疼痛治疗的强度，以及 处方和访问。在目标2中，主要自变量是疼痛治疗的类型，结局是 长期高剂量阿片类药物使用、药物过量以及药物相关住院和急诊 探访对于每个目标，我们将评估种族和民族作为关键的潜在影响因素。预期结果 黑人和西班牙裔受益人与OUD相比， 有或没有OUD的非西班牙裔白人。我们进一步假设非阿片类药物治疗与 阿片类药物相关的不良后果较少，阿片类药物使用的持续时间和剂量较低。少数民族与OUD将有 结果比白人差。这些发现有可能识别和帮助解决慢性疾病中的差异。 通过提供证据来告知未来实践指南的发展， 边缘化群体面临的微妙挑战，如OUD患者和少数民族。

项目成果

Prevalence of opioid and nonopioid pain management therapies among Medicare beneficiaries with musculoskeletal pain conditions from 2016 to 2019.

2016 年至 2019 年患有肌肉骨骼疼痛的医疗保险受益人中阿片类药物和非阿片类药物疼痛管理治疗的流行情况。

• DOI: 10.1016/j.drugalcdep.2023.109930
• 发表时间: 2023
• 期刊: Drug and alcohol dependence
• 影响因子: 4.2
• 作者: Moyo,Patience;Vaillant,Jane;Girard,Anthony;Gairola,Richa;Shireman,TheresaI;Trivedi,AmalN;Merlin,JessicaS;Marshall,BrandonDL
• 通讯作者: Marshall,BrandonDL