Divisions of Analysis, Research, and Practice Integration.
Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Pain Med. 2019 Oct 1;20(10):1948-1954. doi: 10.1093/pm/pny247.
Objective The increased use of opioids to treat chronic pain in the past 20 years has led to a drastic increase in opioid prescribing in the United States. The Centers for Disease Control and Prevention's (CDC's) Guideline for Prescribing Opioids for Chronic Pain recommends the use of nonopioid therapy as the preferred treatment for chronic pain. This study analyzes the prevalence of nonopioid prescribing among commercially insured patients with chronic pain. Design Data from the 2014 IBM® MarketScan® databases representing claims for commercially insured patients were used. International Classification of Diseases, Ninth Revision, codes were used to identify patients with chronic pain. Nonopioid prescriptions included nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics/antipyretics (e.g., acetaminophen), anticonvulsants, and antidepressant medications. The prevalence of nonopioid and opioid prescriptions was calculated by age, sex, insurance plan type, presence of a depressive or seizure disorder, and region. Results In 2014, among patients with chronic pain, 16% filled only an opioid, 17% filled only a nonopioid prescription, and 28% filled both a nonopioid and an opioid. NSAIDs and antidepressants were the most commonly prescribed nonopioids among patients with chronic pain. Having prescriptions for only nonopioids was more common among patients aged 50-64 years and among female patients. Conclusions This study provides a baseline snapshot of nonopioid prescriptions before the release of the CDC Guideline and can be used to examine the impact of the CDC Guideline and other evidence-based guidelines on nonopioid use among commercially insured patients with chronic pain.
目的 在过去的 20 年中,阿片类药物在治疗慢性疼痛方面的应用日益增多,这导致美国阿片类药物的处方量急剧增加。疾病预防控制中心(CDC)的《阿片类药物治疗慢性疼痛指南》建议将非阿片类药物治疗作为慢性疼痛的首选治疗方法。本研究分析了有慢性疼痛商业保险患者中非阿片类药物处方的流行情况。
设计 本研究使用了代表有商业保险患者索赔数据的 2014 年 IBM® MarketScan®数据库的数据。使用国际疾病分类,第 9 版(ICD-9)代码来确定患有慢性疼痛的患者。非阿片类药物处方包括非甾体抗炎药(NSAIDs)、镇痛药/退烧药(如对乙酰氨基酚)、抗惊厥药和抗抑郁药。根据年龄、性别、保险计划类型、是否存在抑郁或癫痫发作障碍以及地区,计算非阿片类药物和阿片类药物处方的流行率。
结果 2014 年,在患有慢性疼痛的患者中,16%的患者仅开阿片类药物处方,17%的患者仅开非阿片类药物处方,28%的患者同时开非阿片类药物和阿片类药物处方。在患有慢性疼痛的患者中,最常开的非阿片类药物是 NSAIDs 和抗抑郁药。仅开非阿片类药物处方的患者中,年龄在 50-64 岁的患者和女性患者更为常见。
结论 本研究提供了在发布 CDC 指南之前非阿片类药物处方的基线情况,可用于研究 CDC 指南和其他循证指南对有慢性疼痛商业保险患者中非阿片类药物使用的影响。
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