Chronic Pain Management and Outcomes in Adults With and Without Opioid Use Disorder

有和没有阿片类药物使用障碍的成年人的慢性疼痛管理和结果

基本信息

批准号：
10302666
负责人：
Patience Moyo Dow
金额：
$ 7.95万
依托单位：
BROWN UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-07-01 至 2023-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10302666
关键词：
Address Adult Adverse event Age Categories Chronic Clinical Practice Guideline Data Development Diagnosis Disabled Persons Dose Elderly Emergency department visit Enrollment Ethnic Origin Event Face Failure Future Goals Health Health Insurance High Prevalence Hispanics Hospitalization Illicit Drugs Incidence Individual Inpatients Insurance Coverage Intervention Knowledge Lead Link Measures Medical Medicare Minority Morbidity - disease rate Morphine Nonpharmacologic Therapy Not Hispanic or Latino Opioid Outcome Outpatients Overdose Pain Pain management Patients Pattern Pharmaceutical Preparations Pharmacy facility Physical therapy Policies Population Practice Guidelines Prevalence Race Research Risk Role Sampling Subgroup Treatment outcome Visit acute care adverse outcome barrier to care beneficiary chronic pain chronic pain management chronic pain patient clinical development comorbidity data warehouse design effective intervention ethnic minority population evidence based guidelines experience gabapentin illicit opioid improved innovation insight milligram mortality non-cancer chronic pain non-drug non-opioid analgesic nondrug therapy off-label use opioid epidemic opioid therapy opioid use opioid use disorder overdose death overdose risk pain outcome pregabalin prescription opioid primary outcome public health insurance racial and ethnic racial and ethnic disparities racial minority secondary analysis social stigma substance use treatment comparison

项目摘要

PROJECT SUMMARY/ABSTRACT Both chronic pain and opioid use disorder (OUD) are linked to opioid-related morbidity and mortality. People with comorbid chronic pain and OUD are vulnerable due to their potential under-treatment of pain and OUD, and elevated risk of adverse outcomes such as transition to illicit drugs and overdose. Despite prominent clinical practice guidelines that emphasize opioid alternatives for pain management, little is known about the use of non- opioid and non-drug pain treatments nationally among chronic pain patients. Even less is known within the context of co-occurring chronic pain and OUD, and racial/ethnic minorities. Using Medicare data, the proposed research aims to: (1) evaluate the relationship between OUD status and type of chronic pain management (prescription opioid, non-opioid medication [e.g., gabapentinoids], or non-drug strategies [e.g., physical therapy), and (2) assess if receipt of non-opioid and non-drug treatments is associated with opioid prescribing and drug- related overdoses and acute care use among patients with and without OUD. Key innovations of the proposed research include its focus on overlapping of chronic pain and OUD, and analysis of newly-available OUD indicators in the Medicare Chronic Condition Data Warehouse. The study will also offer new insight into the use of opioid alternatives and outcomes among disabled and older adults who have a high prevalence of chronic pain, are often prescribed opioids, and have rising OUD and overdose rates. We will analyze a 2016-2018 nationally representative 20% random sample of Medicare beneficiaries using enrollment, inpatient, outpatient, and pharmacy claims data. In Aim 1 the main independent variable is OUD status and the primary outcome is the type of pain treatment received defined as a categorical variable. In a secondary analysis, we will evaluate the intensity of each type of pain treatment as measured by opioid morphine milligram equivalents, and count of prescriptions and visits. In Aim 2, the main independent variable is type of pain treatment and the outcomes are long-term high dose opioid use, drug overdoses, and drug-related hospitalizations and emergency department visits. For each aim, we will assess race and ethnicity as a key potential effect modifier. The expected results are that Black and Hispanic beneficiaries with OUD will be less likely to receive any pain treatment compared to non-Hispanic Whites with or without OUD. We further hypothesize that non-opioid treatment is associated with fewer opioid-related adverse outcomes and lower duration and dose of opioid use. Minorities with OUD will have worse outcomes than Whites. The findings have the potential to identify and help address disparities in chronic pain management by providing evidence to inform the development of future practice guidelines that consider the nuanced challenges faced by marginalized groups such as people with OUD and racial minorities.

项目概要/摘要慢性疼痛和阿片类药物使用障碍 (OUD) 都与阿片类药物相关的发病率和死亡率有关。人与由于疼痛和 OUD 可能未得到充分治疗，慢性疼痛和 OUD 共病很容易受到影响，并且不良后果的风险增加，例如转向非法药物和服用过量。尽管临床表现突出实践指南强调阿片类药物替代品用于疼痛管理，但人们对非阿片类药物的使用知之甚少。全国范围内慢性疼痛患者的阿片类药物和非药物疼痛治疗。圈内知之甚少同时发生的慢性疼痛和 OUD 以及种族/族裔的背景。使用医疗保险数据，建议研究目的是：(1) 评估 OUD 状态与慢性疼痛管理类型之间的关系（处方阿片类药物、非阿片类药物[例如加巴喷丁类药物]或非药物策略[例如物理治疗）， (2) 评估接受非阿片类药物和非药物治疗是否与阿片类药物处方和药物相关患有和不患有 OUD 的患者中相关的药物过量和急性护理使用。拟议的主要创新点研究重点包括慢性疼痛和 OUD 的重叠，以及对新可用 OUD 的分析医疗保险慢性病数据仓库中的指标。该研究还将提供有关使用的新见解慢性病患病率高的残疾人和老年人的阿片类药物替代品和结果疼痛，经常开阿片类药物，并且 OUD 和过量率不断上升。我们将分析2016-2018年使用登记、住院患者、门诊患者、医疗保险受益人的全国代表性 20% 随机样本和药房索赔数据。在目标 1 中，主要自变量是 OUD 状态，主要结果是接受的疼痛治疗类型定义为分类变量。在二次分析中，我们将评估以阿片类药物吗啡毫克当量衡量的每种类型疼痛治疗的强度，以及处方和就诊。在目标 2 中，主要自变量是疼痛治疗类型，结果是长期高剂量使用阿片类药物、药物过量以及与药物相关的住院和急诊室访问。对于每个目标，我们将评估种族和民族作为关键的潜在影响因素。预期结果与 OUD 相比，黑人和西班牙裔受益人接受任何疼痛治疗的可能性较小有或没有 OUD 的非西班牙裔白人。我们进一步假设非阿片类药物治疗与与阿片类药物相关的不良后果更少，阿片类药物的使用持续时间和剂量也更低。拥有 OUD 的少数族裔将拥有结果比白人更糟糕。这些发现有可能确定并帮助解决慢性病的差异疼痛管理，通过提供证据为未来实践指南的制定提供信息，这些指南考虑到边缘化群体（例如 OUD 人群和少数族裔）面临的微妙挑战。