Chronic Pain in Adults on the Rise: A Potential Crisis
https://www.medscape.org/viewarticle/904084
Clinical Context
All clinicians are aware of the mandate to reduce opioid use, but is awareness having an effect? Data from the Centers for Disease Control and Prevention suggest that the tide has shifted in the prescription rate for opioids.[1] Opioid prescription rates reached a peak in 2010 to 2012, but since then, there has been a steady decline. In 2012, the rate of opioid prescriptions per 100 persons in the United States was a staggering 81.3. That figure fell to 58.5 by 2017. Prescription rates for high-dose opioids have fallen by more than half from their peak in 2008.
Nonetheless, 17% of Americans received at least 1 opioid prescription in 2017, and these patients averaged 3.4 prescriptions over the year. There is wide geographic variability in the rate of opioid prescriptions, with rates generally higher in locations with larger proportions of non-Hispanic white residents and more primary care physicians and dentists.
While US healthcare practitioners grapple with the opioid epidemic, we still need to treat the many adults with chronic pain. How many are there, and what are the risk factors for chronic pain? Dahlhamer and colleagues address this subject in their current research.
Study Synopsis and Perspective
Chronic pain affects about 50 million US adults, and “high-impact” chronic pain, which interferes with life or work activities, affects around 20 million adults, new federal data indicate.
“Pain is a component of many chronic conditions, and chronic pain is emerging as a health concern on its own, with negative consequences to individual persons, their families, and society as a whole,” note the authors, led by James Dahlhamer, PhD, from the National Center for Health Statistics, part of the Centers for Disease Control and Prevention.
Their analysis of 2016 National Health Interview Survey data showed that 20.4% of US adults had chronic pain in 2016, and 8.0% had high-impact chronic pain. Both types of pain were more prevalent in women than men (20.8% vs 17.8% and 8.9% vs 7.0%, respectively).
Both types of chronic pain were also more prevalent among older adults, veterans, those previously but not currently employed, those living in poverty or rural areas, and those with public health insurance.
The study was published September 14 in the Morbidity and Mortality Weekly Report, in time for Pain Awareness Month.[2]
$560 Billion in Direct Costs
Chronic pain and high-impact chronic pain have been linked previously to restrictions in mobility and daily activities, dependence on opioids, anxiety, depression, and poor quality of life, the authors write.
Chronic pain contributes to an estimated $560 billion each year in direct medical costs, lost productivity, and disability programs, they note.
As reported by Medscape Medical News, the federal government’s National Pain Strategy, released in the spring of 2016, marked the nation’s first coordinated plan for reducing the burden of chronic pain.
The plan recognized the need for better data to inform action and called for better estimates of chronic pain and high-impact chronic pain in the general population.
Dr Dahlhamer and colleagues say their report “helps fulfill this objective and provides data to inform policymakers, clinicians, and researchers focused on pain care and prevention.”
The study had no commercial funding. Dr Dahlhamer has reported no relevant financial relationships. One author has received honoraria for serving as a member of a research grant review board for the American Pain Society and serves as senior editor for Pain Medicine. Another author has received grants from Pfizer Inc as an investigator of the use and misuse of opioids at Kaiser Permanente Washington Health Research Institute and from inVentive as coinvestigator for US Food and Drug Administration-mandated postmarketing surveillance studies of extended-release opioids.
Morb Mortal Wkly Rep. 2018;67:1001-1006.
Study Highlights
- Researchers used data from the 2016 National Health Interview Survey, which features an in-home interview among community-dwelling adults. The current study focuses on results from respondents at least 18 years of age.
- The survey contained questions about frequency of pain, as well as functional limitations associated with pain.
- Chronic pain was defined by researchers as pain that occurred on at least most days during the last 6 months. High-impact chronic pain was defined by disability in life or work activities resulting from pain on most days during the last 6 months.
- The main study outcome was the prevalence of chronic pain and high-impact chronic pain in 2016. Researchers also assessed sociodemographic factors that might affect the prevalence of pain.
- The study analysis estimated that 50.0 million US adults, or 20.4% of the total adult population, had chronic pain, and 8.0% of US adults, or nearly 20 million individuals, had high-impact chronic pain.
- Variables associated with higher rates of chronic pain included being a woman, unemployment, poverty, lower educational attainment, and residence in a rural area.
- Rates of chronic pain were highest among non-Hispanic white adults compared with other racial/ethnic groups. However, there was no difference in rates of high-impact chronic pain based on race and ethnicity.
- Similarly, veterans had higher rates of chronic pain, but not high-impact chronic pain, compared with nonveterans.
- Another factor associated with higher rates of both chronic pain and high-impact chronic pain among adults younger than 65 years was public health insurance vs either private insurance or no health insurance.
Clinical Implications
- Rates of any opioid and high-dose opioid prescriptions have fallen substantially in the United States from 2012 to 2017, but 17% of Americans still received at least 1 opioid prescription in 2017. Communities with higher rates of opioid prescriptions have higher concentrations of non-Hispanic white residents, as well as more primary care physicians and dentists.
- Approximately 1 in 5 US adults has chronic pain, and the rate of significant disability resulting from pain is 8%. Being a woman, poverty, public health insurance, and non-Hispanic white race were associated with higher rates of chronic pain.
- Implications for the Healthcare Team: The healthcare team should try to use local resources to present an effective and multidisciplinary approach to treating the many US adults with chronic pain.
Filed under: General Problems
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