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

项目摘要/摘要 慢性疼痛和阿片使用障碍(OUD)都与阿片类药物相关的发病率和死亡率有关。具有以下特征的人 共病的慢性疼痛和OUD是脆弱的，因为它们可能得不到疼痛和OUD的治疗，以及 不良后果的风险增加，如转向非法药物和过量服药。尽管临床表现突出 强调阿片类药物替代治疗疼痛的实践指南，对非阿片类药物的使用知之甚少 在全国慢性疼痛患者中进行阿片类药物和非药物疼痛治疗。甚至更少的人知道 慢性疼痛和慢性精神疾病共同发生的背景、种族和族裔少数群体。使用联邦医疗保险数据，建议的 本研究的目的是：(1)评估慢性疼痛管理的OUD状态与类型之间的关系 (处方阿片类药物、非阿片类药物[如加巴喷丁]或非药物策略[如理疗]， 以及(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有关- OUD患者和非OUD患者的相关过量用药和急性护理使用。建议的主要创新 研究包括其对慢性疼痛和OUD重叠的关注，以及对新获得的OUD的分析 医疗保险慢性病数据仓库中的指标。这项研究还将为人们提供对这一用途的新见解 阿片类药物替代品及其在慢性病患病率高的残疾人和老年人中的结局 疼痛，通常是处方的阿片类药物，并有上升的乌德和过量使用率。我们将分析2016-2018年 具有全国代表性的20%使用登记的医疗保险受益人的随机样本，住院患者，门诊患者， 和药房索赔数据。在目标1中，主要自变量是OUD状态，主要结果是 接受疼痛治疗的类型被定义为分类变量。在二次分析中，我们将评估 以阿片类吗啡毫克当量衡量的每种类型疼痛治疗的强度，以及 处方和就诊。在目标2中，主要自变量是疼痛治疗的类型，结果是 长期大剂量阿片类药物使用、药物过量以及与药物相关的住院和急诊科 来访。对于每个目标，我们将评估种族和民族作为一个关键的潜在影响修饰符。预期结果 与以下情况相比，患有OUD的黑人和西班牙裔受益人接受疼痛治疗的可能性较小 非西班牙裔白人加或不加OUD。我们进一步假设非阿片类药物治疗与 与阿片类药物相关的不良后果较少，阿片类药物的使用时间和剂量较低。有OUD的少数族裔将拥有 比白人更糟糕的结果。这些发现有可能识别并帮助解决慢性疾病的差异 通过提供证据，为制定未来的实践指南提供信息，这些指南考虑了 边缘群体，如黑人和少数族裔面临的微妙挑战。

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.