(Press-News.org) A new study led by the Johns Hopkins Bloomberg School of Public Health finds that during a decade when prescription opioid use has skyrocketed, the identification and treatment of pain has failed to improve, and the use of non-opioid analgesics has plateaued, or even declined. The study was published online September 13 in the journal Medical Care.
"There is an epidemic of prescription opioid addiction and abuse in the United States," notes G. Caleb Alexander, MD, MS, associate professor of Epidemology and Medicine and co-director of the Johns Hopkins Center for Drug Safety and Effectiveness. "We felt it was important to examine whether or not this epidemic has coincided with improved identification and treatment of pain."
Alexander and his fellow researchers used the National Ambulatory Medical Care Survey, designed by the CDC/National Center for Health Statistics, to analyze trends from 2000 to 2010 associated with patients seeking medical treatment for non-cancer pain. They found no significant change in the proportion of pain visits -- approximately one-half -- treated with pain relievers.
During this time, non-opioid (analgesic) prescriptions remained stable, consisting of 26-29 percent of pain visits. However, opioid (morphine-related) prescriptions nearly doubled, from 11 percent in 2000 to 19 percent in 2010. Of approximately 164 million pain visits in 2010, roughly half were treated with some kind of pain relieving drug: 20 percent with an opioid and 27 percent with a non-opioid pain reliever.
Alexander and colleagues also examined visits for new-onset musculoskeletal pain and in spite of similar increases in opioid prescribing, the results showed a significant decrease in non-opioid analgesics prescriptions from 38 to 29 percent between 2000 and 2010, despite a lack of evidence showing opioids are more effective or safer than non-opioid treatments for such pain.
Chronic pain affects nearly 100 million U.S. adults and carries major costs in terms of health care and lost productivity. Initiatives designed to increase patient and provider awareness of pain have come with unintended consequences. Prescription opioid abuse has been increasingly documented in emergency department visits and deaths. "By 2008, the annual number of fatal drug poisonings surpassed those of motor vehicle deaths and overdose deaths attributable to prescription drugs exceeded those of cocaine and heroin combined," Alexander and colleagues write.
The new study is one of the first to focus on trends in pain treatment in ambulatory care -- that is, office and clinic visits.
The results highlight the importance of balancing the risks and benefits of analgesics prescribed in the primary care setting. "The majority of pain medications are prescribed by primary care physicians, who treat over half of the chronic pain in the United States," notes Matthew Daubresse, MHS, lead author of the report. "Pain specialists only treat a fraction of these patients."
"We found that not only have the rates of treated pain not improved, but in many cases, use of safer alternatives to opioids, such as medicines like ibuprofen and acetaminophen, have either stayed flat or declined," says Alexander. "This suggests that efforts to improve the identification and treatment of pain have backfired, due to an over-reliance on prescription opioids that have caused incredible morbidity and mortality among patients young and old alike."
In response to the growing opioid epidemic, on September 10th, 2013, the Food and Drug Administration announced new labeling changes and postmarket study requirements for extended-release and long-acting opioid analgesics. "These regulatory changes may help prescribers and patients to better appreciate the risks of these therapies," says Matthew Daubresse. "Despite this, the ultimate impact of the FDA's labeling change has yet to be seen."
Alexander and his colleagues conclude: "Policy makers, professional organizations, and providers should re-evaluate prior efforts to improve the identification, treatment, and management of nonmalignant pain and promote approaches that adequately reflect the importance on non-opioid and non-pharmacologic treatments."
###
"Ambulatory Diagnosis and Treatment of Non-Malignant Pain in the United States, 2000-2010," was written by Matthew Daubresse, Hsien-Yen Chang, Shilpa Viswanathan, Nilay Shah, Randall Stafford, Stefan Kruszewski and G. Caleb Alexander.
The research was funded in part by the Agency for Healthcare Research and Quality (RO1 HS0189960).
As opioid use soars, no evidence of improved treatment of pain
2013-09-16
ELSE PRESS RELEASES FROM THIS DATE:
Specific sugar molecule causes growth of cancer cells
2013-09-16
In co-operation with a research group from Singapore, scientists at University of Copenhagen have shown that immature sugar molecules in the form of truncated O-glycans aid growth properties of cancer cells. Previously, scientists have not been able to decode the significance of these truncated O-glycans, and therefore, the results, which were recently published in the journal PNAS, represent an important contribution to understanding the growth of cancer cells as well as the work towards developing a cure that can limit or stop the growth.
Catharina Steentoft, PhD student ...
Schizophrenia: It's in the wiring of the brain
2013-09-16
Philadelphia, PA, September 16, 2013 – Just as wires must be insulated to effectively carry electrical impulses, nerve cells must be insulated by myelin to effectively transmit neural impulses. Using typical magnetic resonance imaging or MRI, one can visually distinguish parts of the brain that look white and parts that look gray. Myelin is most prevalent in the white matter because this component of the brain tissue is principally comprised by the nerve cell projections (axons) that are covered by myelin and that transmit information from one part of the brain to another. ...
Intelligent use of electronic data helps the medicine go down, say researchers
2013-09-16
Electronic data routinely gathered in hospitals can be used as a warning system for missed doses of prescribed medicine and making improvements to patient safety, says a new study.
A team from the Universities of Leicester and Birmingham found that the secondary use of data from an electronic prescribing and decision support system in an English hospital led to a 'substantial and sustained' reduction in rates of missed or delayed doses of medicines.
Published in the world-leading health policy journal Milbank Quarterly, the study looked at how using the electronic ...
Hospital study finds connection between dementia, delirium and declining health
2013-09-16
More than half of all patients with pre-existing dementia will experience delirium while hospitalized. Failing to detect and treat their delirium early leads to a faster decline of both their physical and mental health, according to health researchers.
"This study is important, as delirium is often overlooked and minimized in the hospital setting, especially in persons with dementia," said Donna M. Fick, Distinguished Professor of Nursing at Penn State and principal investigator for this study. "And it illustrates that delirium is deadly, costly and impacts patient functioning." ...
Environmentally friendly cement is stronger than ordinary cement
2013-09-16
New research from the Niels Bohr Institute shows that cement made with waste ash from sugar production is stronger than ordinary cement. The research shows that the ash helps to bind water in the cement so that it is stronger, can withstand higher pressure and crumbles less. At the same time, energy is saved and pollution from cement production is reduced. The results are published in the scientific journal, Scientific Reports.
Cement is comprised of chalk and clay, which are mixed together and heated at high temperatures in a cement kiln. The mixture is then crushed ...
New model should expedite development of temperature-stable nano-alloys
2013-09-16
Researchers from North Carolina State University have developed a new theoretical model that will speed the development of new nanomaterial alloys that retain their advantageous properties at elevated temperatures.
Nanoscale materials are made up of tiny crystals, or grains, that are less than 100 nanometers in diameter. These materials are of interest to researchers, designers and manufacturers because two materials can have the same chemical composition but very different mechanical properties depending on their grain size. For example, materials with nanoscale grains ...
Misread heart muscle gene a new clue to risk of sudden cardiac death
2013-09-16
Scientists have discovered that a drug which increases the risk of sudden cardiac death interacts with mistranslated protein-coding genes present in heart muscle.
The cardiac drug flecainide was developed to prevent and treat serious arrhythmias in the ventricles - the main pumps of the heart. These cause very rapid heart rates which can be lethal if unchecked. However in clinical trials, flecainide, and its sister molecule encainide, were reported to more than double the risk of sudden cardiac death.
Joint work by researchers in the Department of Chemistry and Warwick ...
Model of dangerous bee disease in Jersey provides tool in fight against honeybee infections
2013-09-16
Scientists at the University of Warwick have modelled an outbreak of the bee infection American foulbrood in Jersey, using a technique which could be applied to other honeybee diseases such as European foulbrood and the Varroa parasite.
As well as modelling how bee infections spread, the method also allows scientists to simulate various disease control interventions in order to measure their efficacy.
The researchers used two sets of data gathered two months apart during an outbreak of American foulbrood in Jersey in the summer of 2010. This provided two 'snapshots' ...
Cold sore linked to mutation in gene, study suggests
2013-09-16
Why some people are troubled by cold sores while others are not has finally been explained by scientists.
Cold sores affect around one in five people but, until now, no one has been sure why some are more prone to the virus that causes them.
Researchers at the University of Edinburgh have found that people affected by cold sores have a mutation in a gene, which means their immune system is not able to prevent them from developing.
Cold sores are caused by a strain of the herpes simplex virus – herpes simplex virus type 1 (HSV-1). Between 80 and 90 per cent of people ...
GOES Satellite catches 3 tropical cyclones in 1 shot, sees Gabrielle absorbed
2013-09-16
There were three tropical cyclones between the north Eastern Pacific and the North Atlantic Ocean on Saturday, Sept. 14, and NOAA's GOES-East satellite captured them in one image created by NASA. Because Mexico was being hit with Tropical Storm Ingrid and Manuel, both coasts were under Tropical Storm Warnings. The National Hurricane Center cautioned that some areas in eastern and western Mexico may receive up to two feet of rainfall from each storm!
NASA's GOES Project at the NASA Goddard Space Flight Center uses the data gathered by NOAA's GOES series of satellites and ...