30% of Chronic Pain Sufferers Use No Pain Management Techniques, New Study Reveals

A recent cross-sectional study reveals that, among adults battling chronic pain in the United States, over 50% had relied on nonpharmacologic pain management techniques during the preceding 3 months, compared with only about 10% who used both opioids and nonpharmacologic techniques.  Fewer than 5% used opioids exclusively and over 30% did not report utilizing any pain management techniques.

Questions unanswered by previous data

In 2019, the Centers for Disease Control and Prevention (CDC) used data from the 2019 National Health Interview Survey (NHIS) to arrive at the estimate that some 50.2 million adults in the US experience chronic pain.  A subsequent CDC publication from NHIS determined that ~1 in 5 of these US adults with chronic pain used prescription opioids.

However, authors of a new research letter published in a recent issue of JAMA Network Open notes that neither study determined whether opioids were used for acute or for chronic pain, nor did either explore other pain management techniques patients used.  Their premise in instituting their study is that a better understanding of effective nonopioid pain management techniques is needed in order to reduce patients’ reliance on opioids for chronic pain.

A study cohort of >31k

Under principal investigator Cornelius Groenewald, MB, ChB, an associate professor of anesthesiology and pain medicine at the University of Washington in Seattle, a research team for the first time examined the NHIS database to calculate national estimates of opioid and nonopioid pain management techniques used by US adults with chronic pain.

Demographically, of the study’s 31,916 patients, 64% were female, 68.5% non-Hispanic white, 13% Hispanic, and 10.9% non-Hispanic Black.  Nearly 71% (22,621) were 18 to 64 years of age, with 29.1% (9,295) at least 65 years of age.

The team surveyed the participants, asking them to report on their use of any of 11 pain management techniques during the preceding 3 months.  The researchers then grouped and coded these 11 techniques into 6 categories:

• opioids for chronic pain;
• opioids for acute pain;
• physical, occupational, or rehabilitative therapy;
• psychological and psychotherapeutic therapies (eg, cognitive behavioral therapy);
• complementary therapies (chiropractic, massage, yoga or tai chi, mediation); or
• other (self-management, pain peer support group, and other methods for pain management).

Participants were not specifically asked about their use of nonopioid pharmacological pain treatments.  Next, survey-weighted prevalence rates for each pain management technique were calculated for selected sociodemographic characteristics.

Opioids, age, income, and education

Prescription opioid use for chronic pain was more common among older individuals: 19.3% for those aged 45 to 64 years versus 8.4% for those aged 18 to 44 years.  Females were also more likely to use prescription opioids: 16.9% versus 13.1% of males.  Insured individuals were more prone to taking prescribed opioids as well: 16.3% versus 5.8% of those who were uninsured.

Prescription opioids also were linked to education level, with 17.0% prevalence among those with a high school education or lower compared with 13.8% for those with more than a high school education.  Likewise, those with annual household incomes exceeding $100,000 had an 8.7% frequency rate of prescription opioid use versus 19.8% for those households reporting less than a $35,000 annual income.

Nonpharmacologic techniques under tapped

The most commonly reported nonpharmacologic pain management technique was complementary therapy, used by 35.4% of those surveyed, followed by 18% who used physical, occupational, or rehabilitative therapies.  Only 5.1% of survey respondents had used self-management programs, 3.8% psychological or psychotherapeutic interventions, and 1.8% chronic pain peer support groups.

Those who reported employing these complementary and psychological or psychotherapeutic interventions were more likely to be younger females and to have attained a higher education level than those who did not employ these pain management techniques.  Individuals who reported using physical, occupational, or rehabilitative therapy also tended to be older females with medical insurance and having a higher level of education than those not using these modalities.

Surprises and barriers

“The most surprising finding was that very few adults with chronic pain used psychological therapies or psychotherapy for the treatment of their chronic pain,” Groenewald stated in an online interview about the study results.  He also noted that significant and well-known barriers to using such approaches remain including both patient awareness and availability of such therapies in the US as well as their inadequate coverage under insurance plans.

He added that even though the medical literature demonstrates that psychological therapies can be extremely successful for chronic pain management, many non-psychologist medical practitioners are themselves not very familiar with these strategies’ effectiveness for some patients.

Further, while he and his team found it reassuring that over one-third of study participants had employed complementary and alternative medicine approaches in combatting their chronic pain, and more than 1 in 5 individuals had tried physical or occupational therapy, he stated that “it would be encouraging…if those percentages improved.”

“While effective for some, opioids prescribed for chronic pain management remain an important determinant of the national opioid crisis,” the investigators write.

In providing baseline information on opioid and nonopioid pain management techniques used for chronic pain, they conclude, their study findings “serve as a benchmark for evaluating the outcome of health care policies aimed at reducing prescription opioid use.”

The full text of Dr. Groenewald and colleagues’ important research letter can be found at no cost here:  “Prevalence of Pain Management Techniques Among Adults With Chronic Pain in the United States, 2019.”