TY - JOUR
T1 - Longitudinal pattern of pain medication utilization in peripheral neuropathy patients
AU - Callaghan, Brian C.
AU - Reynolds, Evan
AU - Banerjee, Mousumi
AU - Kerber, Kevin A.
AU - Skolarus, Lesli E.
AU - Burke, James F.
N1 - Funding Information:
B.C. Callaghan receives research support from Impeto Medical Inc. He performs medical consultations for Advance Medical, consults for a PCORI grant, consults for the immune tolerance network, and performs medical legal consultations. L.E. Skolarus has received compensation from Bracket Global. J.F. Burke has received compensation from Astra Zeneca for his role on the adjudication committee of the SOCRATES trial. The remaining authors have no conflicts of interest to declare.
Funding Information:
B.C. Callaghan is supported by a NIH K23 grant (NS079417) and a VA CSRD Merit (CX001504). K.A. Kerber is supported by NIH/ NCRR K23 RR024009, AHRQ R18 HS017690, NIH/NIDCD R01DC012760, and AHRQ R18HS022258. L.E. Skolarus is supported by NIH/NIMHD R01MD00887, NIH/NIMHD R01MD011516, and NIH/NMHD U01MD010579. J.F. Burke is supported by NINDS K08 NS082597 and NIH/NIMHD R01MD00887. Author contributions: B.C. Callaghan, E. Reynolds, M. Banerjee, and J.F. Burke were involved in the study design, interpretation of the statistical analysis, and critical revisions of the manuscript. B.C. Callaghan also wrote the manuscript. E. Reynolds also performed the statistical analyses. K.A. Kerber and L.E. Skolarus were involved in the interpretation of the statistical analysis, and critical revisions of the manuscript.
Publisher Copyright:
© 2018 International Association for the Study of Pain.
PY - 2019/3/1
Y1 - 2019/3/1
N2 - We aimed to investigate the pattern and utilization of neuropathic pain medications in peripheral neuropathy patients. Using a privately insured, health care claims database from 2001 to 2014, we identified a retrospective cohort of incident peripheral neuropathy patients (validated ICD-9 definition) after excluding other chronic pain conditions. Outcome measures included opioid prescriptions, chronic opioid therapy (greater than or equal to 90 days of continuous supply), guideline-recommended medications for painful peripheral neuropathy (serotonin reuptake inhibitors, tricyclic antidepressants, and gabapentinoids), and pain specialists (neurologists, physiatrists, and anesthesiologists). Multivariable logistic regression was used to evaluate associations of patient-level factors with these outcomes. The peripheral neuropathy population included 14,426 individuals with a mean (SD) age of 43.1 years (2.8) and 52.4% men followed for 3.1 (1.7) years before and 4.5 (1.4) years after the diagnosis. In this population, 65.9% received ≥1 opioid prescription, and 8.8% received chronic opioid therapy. Of those receiving chronic opioid therapy, only 26.4% received a guideline-recommended medication before chronic opioid status. For guideline-recommended medications, 35.7% received ≥1, 12.4% ≥2, and 3.8% ≥3 different medications. No patient-level factors were associated with both high opioid utilization (initiation and chronic use) and low guideline-recommended medication utilization. Pain specialists were associated with high opioid utilization and high guideline-recommended medication utilization. In conclusion, opioid initiation and transition to chronic opioid therapy are frequent in a peripheral neuropathy population despite few patients receiving more than one guideline-recommended medication. Efforts to decrease opioid utilization and increase guideline-recommended medication use are needed to improve current neuropathic pain treatment.
AB - We aimed to investigate the pattern and utilization of neuropathic pain medications in peripheral neuropathy patients. Using a privately insured, health care claims database from 2001 to 2014, we identified a retrospective cohort of incident peripheral neuropathy patients (validated ICD-9 definition) after excluding other chronic pain conditions. Outcome measures included opioid prescriptions, chronic opioid therapy (greater than or equal to 90 days of continuous supply), guideline-recommended medications for painful peripheral neuropathy (serotonin reuptake inhibitors, tricyclic antidepressants, and gabapentinoids), and pain specialists (neurologists, physiatrists, and anesthesiologists). Multivariable logistic regression was used to evaluate associations of patient-level factors with these outcomes. The peripheral neuropathy population included 14,426 individuals with a mean (SD) age of 43.1 years (2.8) and 52.4% men followed for 3.1 (1.7) years before and 4.5 (1.4) years after the diagnosis. In this population, 65.9% received ≥1 opioid prescription, and 8.8% received chronic opioid therapy. Of those receiving chronic opioid therapy, only 26.4% received a guideline-recommended medication before chronic opioid status. For guideline-recommended medications, 35.7% received ≥1, 12.4% ≥2, and 3.8% ≥3 different medications. No patient-level factors were associated with both high opioid utilization (initiation and chronic use) and low guideline-recommended medication utilization. Pain specialists were associated with high opioid utilization and high guideline-recommended medication utilization. In conclusion, opioid initiation and transition to chronic opioid therapy are frequent in a peripheral neuropathy population despite few patients receiving more than one guideline-recommended medication. Efforts to decrease opioid utilization and increase guideline-recommended medication use are needed to improve current neuropathic pain treatment.
KW - Epidemiology
KW - Guideline recommended medications
KW - Opioids
KW - Pain
KW - Peripheral neuropathy
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UR - http://www.scopus.com/inward/citedby.url?scp=85061570067&partnerID=8YFLogxK
U2 - 10.1097/j.pain.0000000000001439
DO - 10.1097/j.pain.0000000000001439
M3 - Article
C2 - 30418352
AN - SCOPUS:85061570067
SN - 0304-3959
VL - 160
SP - 592
EP - 599
JO - Pain
JF - Pain
IS - 3
ER -