Use of Nonopioid Pain Management Has Increased in Autoimmune Rheumatic Diseases

Despite the shift away from opioid use as a standard of care in pain management, current clinical guidelines are outdated, and data on alternative pain treatments for conditions such as ARDs are limited.

Therefore, researchers conducted a retrospective cohort study to investigate pain management treatment patterns among patients newly diagnosed with ARDs. The outcomes of interest included annual trends in the use of opioids, anticonvulsants, antidepressants, skeletal muscle relaxants, NSAIDs, topical pain medications, and physical or occupational therapy from 2007 to 2021.

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Annual trends in pain management modalities in patients with newly diagnosed autoimmune rheumatic diseases in the USA from 2007 to 2021: an administrative claims-based study

Summary

Background

Autoimmune rheumatic diseases have distinct pathogenic mechanisms and are causes of disability and increased mortality worldwide. In this study, we aimed to examine annual trends in pain management modalities among patients with autoimmune rheumatic diseases. Methods

We identified newly diagnosed patients with ankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis, Sjögren's syndrome, systemic sclerosis, or systemic lupus erythematosus (SLE) in the Merative Marketscan Research Databases from 2007 to 2021. The database includes deidentified inpatient and outpatient health encounters with employment-sponsored health insurance claims in the USA. We found minimal occurrences of multiple overlapping conditions and included only the initial recorded diagnosis for each patient. We determined the annual incidence of patients treated with opioids, anticonvulsants, antidepressants, skeletal muscle relaxants, non-steroidal anti-inflammatory drugs (NSAIDs), topical analgesics, and physical therapy in the year following diagnosis. Logistic regression was used to estimate the association between calendar year and outcomes, adjusted for age, sex, and region.

Findings

We included 141 962 patients: 10 927 with ankylosing spondylitis, 21 438 with psoriatic arthritis, 71 393 with rheumatoid arthritis, 16 718 with Sjögren's syndrome, 18 018 with SLE, and 3468 with systemic sclerosis. 107 475 (75·7%) were women and 34 487 (24·3%) were men. Overall, the incidence of opioid use increased annually until 2014 by 4% (adjusted odds ratio [aOR] 1·04 [95% CI 1·03–1·04]) and decreased annually by 15% after 2014 (0·85 [0·84–0·86]). The incidence of physical therapy use increased annually by 5% until 2014 (aOR 1·05 [95% CI 1·04–1·06]), with a slight decrease annually by 1% after 2014 (0·99 [0·98–1·00]). The incidence of anticonvulsant use increased annually by 7% until 2014 (aOR 1·07 [95% CI 1·07–1·08]) and did not significantly change after 2014 (1·00 [0·99–1·00]). Before 2014, the incidence of NSAIDs use increased by 2% annually (aOR 1·02 [95% CI 1·02–1·03]); however, after 2014, the incidence decreased annually by 5% (0·95 [0·95–0·96]). These trends did not differ by sex except for NSAID use before 2014 (pinteraction=0·02) and topical analgesic use after 2014 (pinteraction=0·0100).

Interpretation

Since 2014, the use of non-opioid pain management modalities has increased or stabilised, whereas opioid and NSAID use has declined. Future studies are needed to evaluate the effectiveness of these changes, and the effects they have had on outcomes such as quality of life, disability, and function.

Funding

National Institute of Arthritis and Musculoskeletal and Skin Diseases.

https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(24)00120-6/abstract