Scientists from Michigan Medicine found that after the Centers for Disease Control and Prevention released a guideline for prescribing opioids to patients experiencing chronic pain in 2016, the prescribing rate of non-opioid pain medication increased each year.
They say the findings suggest more clinicians are carefully considering the risks of prescribing opioids.
The research is published in JAMA Network Open and was conducted by Jason Goldstick et al.
The 2016 guideline aimed to help U.S. clinicians treat adult patients for chronic pain while weighing the benefits and risks of prescribing opioids, as more Americans died of an opioid-related overdose.
In the study, the team used data from over 15 million patients to analyze the prescribing rates of nonopioid pain medications, such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs).
They found that the odds of prescribing a nonopioid pain medication in 2016 were 3% higher than expected from pre-guideline estimates for the same year. That number increased to 8% in 2017 and 9.7% in 2018.
These findings suggest that clinicians have been prescribing nonopioid pain medications more frequently since the 2016 guideline was released, and that may mean that they’ve considered opioid therapy only if its expected benefits exceeded the expected risks to the patient.
The team says the 2016 guideline encouraged caution in prescribing opioids, and it was possible that it could have reduced the use of pain treatments overall.
The increase in nonopioid pain medication prescribing coincided with a significant drop in opioid prescribing over the same period, consistent with other research showing reductions in opioid prescribing following the 2016 guideline release.
Increases in nonopioid pain medication prescribing were consistent across several patient subpopulations, including those with recent opioid exposure, as well as those with anxiety or mood disorders.
The study provides an encouraging sign that patients were more often offered other treatments for pain than before the guideline, rather than only being offered opioids less often.
Researchers say the changes in prescribing may have also led to a shift toward the use of some nonpharmacologic treatments, including physical therapy and cognitive behavioral therapy.
They note additional research on changes in nonpharmacologic pain treatments, as well as undertreatment of pain and patient pain outcomes, are needed to gain a fuller understanding of changes to the pain management landscape following the 2016 guideline release.
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