Treating patients in pain with nonpharmacologic therapy (for example, physical therapy and/or complementary medicine) in place of or in combination with opioid therapy is known to help reduce pain and improve physical function without the risk of addiction. A report in JAMA Network Open now suggests that during the early months of the COVID-19 pandemic, patients in pain were more likely to receive opioids than nonpharmacologic therapy compared with the same period the previous year.
“The decrease in nonpharmacologic therapy and increase in opioid prescription during the COVID-19 pandemic found in this cross-sectional study … may exacerbate the U.S. opioid epidemic,” wrote Byungkyu Lee, Ph.D., of Indiana University Bloomington and colleagues. “[P]olicies that markedly expand the use of nonaddictive treatments, such as physical therapy for chronic pain management, are urgently needed.”
Lee and colleagues studied weekly claims data from 24 million U.S. patients in Optum’s nationwide commercial insurance database from January 1, 2019, through September 31, 2020. The researchers specifically focused their analysis on patients in the database with limb or extremity pain; joint pain and nonsystemic, noninflammatory arthritic disorders; back pain; and neck pain. They compared weekly rates of opioid prescriptions to the patients, the strength and duration of opioid prescriptions, and the use of nonpharmacologic therapy during the pandemic compared with the patterns in 2019.
The sample included over 21.4 million people enrolled in Optum during the first three quarters in 2019 and over 20.7 million people enrolled during the first three quarters of 2020.
“During the COVID-19 pandemic, the proportion of patients receiving a pain diagnosis was smaller than that for the same period in 2019 (mean difference, −15.9%),” Lee and colleagues reported. “Patients with pain were more likely to receive opioids (mean difference, 3.5%) and less likely to receive nonpharmacologic therapy (mean difference, −6.0%),” they continued. Opioid prescriptions were also written for longer periods and more potent doses early in the pandemic (defined by authors as the period from mid-March 2020 to July 4, 2020) compared with the same period in 2019. Additional analysis revealed that patients were more likely to have been transitioned from nonpharmacologic therapy to opioid prescriptions for pain management during the COVID-19 pandemic than in the year before.
“We found that under conditions of reduced access to diverse treatment options, practitioners and patients resorted to riskier alternatives to manage acute and chronic pain,” Lee and colleagues concluded. “After the pandemic, nonpharmacologic therapy will likely continue to be inaccessible for many patients because of factors such as cost, underinsurance, lack of transportation, lack of childcare, or inability to take time off work. These barriers disproportionately affect people in rural areas, Black and Latinx patients, gender and sex minorities, and those in disadvantaged socioeconomic groups and thus may contribute to broader disparities in opioid use disorders and overdose.”
For related news, see the Psychiatric News Alert “Drug Overdose Deaths Reach Record High During Pandemic.”
(Image: iStock/FG Trade)
Learn About Candidates in APA’s 2022 Election in Virtual Town Halls
APA members have the opportunity to virtually meet the 2022 candidates during a series of four town hall sessions. The next town hall will take place tonight (December 14) at 8 p.m. ET. Each session will include a seven-minute presentation from each candidate on their platform followed by a Q&A.
- December 14: Area 3 trustee (elected by Area 3 members)
- December 15: Area 6 trustee (elected by Area 6 members)
- December 16: Resident-fellow member (RFM) trustee-elect (elected by RFMs)