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Eighteen-Year Trends in the Prevalence of, and Health Care Use for, Noncancer Pain in the United States: Data from the Medical Expenditure Panel Survey

  • Richard L. Nahin
    Correspondence
    Address reprint requests to Richard L. Nahin, National Center for Complementary and Integrative Health, National Institutes of Health, 6707 Democracy Boulevard, Suite 401, Bethesda, Maryland, 20892-5475.
    Affiliations
    National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, Maryland
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  • Bryan Sayer
    Affiliations
    Social & Scientific Systems, Silver Spring, Maryland
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  • Barbara J. Stussman
    Affiliations
    National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, Maryland
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  • Termeh M. Feinberg
    Affiliations
    Yale University School of Medicine, Yale Center for Medical Informatics, New Haven Connecticut

    Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut

    University of Maryland Baltimore School of Medicine, Center for Integrative Medicine, Baltimore, Maryland
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Published:January 15, 2019DOI:https://doi.org/10.1016/j.jpain.2019.01.003

      Highlights

      • Since 1997/1998, pain prevalence in U.S. adults increased by 25%.
      • By 2013/2014, about 68 million adults had pain that interfered with work activities.
      • Increased levels of pain-related interference were associated with higher opioid use.
      • The use of strong, but not weak, opioids for pain management increased over time.
      • Visits to health care providers for pain management decreased over time.

      Abstract

      We used data from the nationally representative Medical Expenditure Panel Survey to determine the 18-year trends in the overall rates of noncancer pain prevalence and pain-related interference, as well as in health care use attributable directly to pain management. The proportion of adults reporting painful health condition(s) increased from 32.9% (99.7% confidence interval [CI] = 31.6–34.2%;120 million adults) in 1997/1998 to 41.0% (99.7% CI = 39.2–42.4%; 178 million adults) in 2013/2014 (Ptrend < .0001). Among adults with severe pain-related interference associated with their painful health condition(s), the use of strong opioids specifically for pain management more than doubled from 11.5% (99.7% CI = 9.6–13.4%) in 2001/2002 to 24.3% (99.7% CI = 21.3–27.3%) in 2013/2014 (Ptrend < .0001). A smaller increase (Pinteraction < .0001) in strong opioid use was seen in those with minimal pain-related interference: 1.2% (99.7% CI = 1.0–1.4%) in 2001/2002 to 2.3% (99.7% CI = 1.9–2.7%) in 2013/2014. Small but statistically significant decreases (Ptrend < .0001) were seen in 1) the percentage of adults with painful health condition(s) who had ≥1 ambulatory office visit for their pain: 56.1% (99.7% CI = 54.2–58.0%) in 1997/1998 and 53.3% (99.7% CI = 51.4–55.4%) in 2013/2014; 2) the percentage who had ≥1 emergency room visit for their pain; 9.9% (99.7% CI = 8.6–11.2%) to 8.8% (99.7% CI = 7.9–9.7%); and 3) the percentage with ≥1 overnight hospitalization for their pain: 3.2% (99.7% CI = 2.6–4.0%) to 2.3% (99.7% CI = 1.8–2.8%).

      Perspective

      Our data illustrate changes in the management of painful health conditions over the last 2 decades in the United States. Strong opioid use remains high, especially in those with severe pain-related interference. Additional education of health care providers and the public concerning the risk/benefit ratio of opioids appears warranted.

      Key words

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      References

      1. Agency for Healthcare Research and Quality: MEPS-HC panel design and collection process. Rockville, MD, Agency for Healthcare Research and Quality. Available at: www.meps.ahrq.gov/mepsweb/survey_comp/hc_data_collection.jsp. Accessed July 26, 2018

        • Ahmedani BK
        • Peterson EL
        • Wells KE
        • Lanfear DE
        • Williams LK
        Policies and events affecting prescription opioid use for non-cancer pain among an insured patient population.
        Pain Physician. 2014; 17: 205-216
        • Barry DT
        • Pilver C
        • Potenza MN
        • Desai RA
        Prevalence and psychiatric correlates of pain interference among men and women in the general population.
        J Psychiatr Res. 2012; 46: 118-127
        • Barth K.S.
        • Guille C.
        • McCauley J.
        • Brady K.T
        Targeting practitioners: A review of guidelines, training, and policy in pain management.
        Drug Alcohol Depend. 2017; 173: S22-S30
        • Brennan F
        • Carr DB
        • Cousins M
        Pain management: A fundamental human right.
        Anesthes Analges. 2007; 105: 205-221
        • Brox JI
        • Reikerås O
        • Nygaard Ø
        • Sørensen R
        • Indahl A
        • Holm I
        • Keller A
        • Ingebrigtsen T
        • Grundnes O
        • Lange JE
        • Friis A
        Lumbar instrumented fusion compared with cognitive intervention and exercises in patients with chronic back pain after previous surgery for disc herniation: A prospective randomized controlled study.
        Pain. 2006; 122: 145-155
        • Burch RC
        • Loder S
        • Loder E
        • Smitherman TA
        The prevalence and burden of migraine and severe headache in the United States: Updated statistics from government health surveillance studies.
        Headache. 2015; 55: 21-34
        • Carragee EJ
        • Hurwitz EL
        • Cheng I
        • Carroll LJ
        • Nordin M
        • Guzman J
        • Peloso P
        • Holm LW
        • Côté P
        • Hogg-Johnson S
        • van der Velde G
        • Cassidy JD
        • Haldeman S
        • Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders
        Treatment of neck pain: Injections and surgical interventions: Results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.
        Spine. 2008; 33: S153-S169
        • Caudill-Slosberg MA
        • Schwartz LM
        • Woloshin S
        Office visits and analgesic prescriptions for musculoskeletal pain in US: 1980 vs. 2000.
        Pain. 2014; 109: 514-519
      2. Centers for Disease Control and Prevention: Opioid oral morphine milligram equivalent conversion factors. Available at: www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/Downloads/Opioid-Morphine-EQ-Conversion-Factors-Aug-2017.pdf. Accessed July 7, 2018

        • Chou EY
        • Parmar BL
        • Galinsky AD
        Economic insecurity increases physical pain.
        Psychol Sci. 2016; 27: 443-454
        • Chou R
        • Fanciullo GJ
        • Fine PG
        • Adler JA
        • Ballantyne JC
        • Davies P
        • Donovan MI
        • Fishbain DA
        • Foley KM
        • Fudin J
        • Gilson AM
        • Kelter A
        • Mauskop A
        • O'Connor PG
        • Passik SD
        • Pasternak GW
        • Portenoy RK
        • Rich BA
        • Roberts RG
        • Todd KH
        • Miaskowski C
        • American Pain Society-American Academy of Pain Medicine Opioids Guidelines Panel
        Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain.
        J Pain. 2009; 10: 113-130
        • Chou R
        • Loeser JD
        • Owens DK
        • Rosenquist RW
        • Atlas SJ
        • Baisden J
        • Carragee EJ
        • Grabois M
        • Murphy DR
        • Resnick DK
        • Stanos SP
        • Shaffer WO
        • Wall EM
        • American Pain Society Low Back Pain Guideline Panel
        Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: An evidence-based clinical practice guideline from the American Pain Society.
        Spine. 2009; 34: 1066-1077
        • Cisternas MG
        • Murphy LB
        • Yelin EH
        • Foreman AJ
        • Pasta DJ
        • Helmick CG
        Trends in medical care expenditures of US adults with arthritis and other rheumatic conditions 1997 to 2005.
        J Rheumatol. 2009; 36: 2531-2538
        • Daubresse M
        • Chang HY
        • Yu Y
        • Viswanathan S
        • Shah ND
        • Stafford RS
        • Kruszewski SP
        • Alexander GC
        Ambulatory diagnosis and treatment of nonmalignant pain in the United States, 2000-2010.
        Med Care. 2013; 51: 870-878
        • Davis MA
        • Onega T
        • Weeks WB
        • Lurie JD
        Where the United States spends its spine dollars: Expenditures on different ambulatory services for the management of back and neck conditions.
        Spine. 2012; 37: 1693-1701
        • Day MA
        • Thorn BE
        The relationship of demographic and psychosocial variables to pain-related outcomes in a rural chronic pain population.
        Pain. 2010; 151: 467-474
        • Deyo RA
        • Mirza SK
        • Turner JA
        • Martin BI
        Overtreating chronic back pain: Time to back off?.
        J Am Board Fam Med. 2009; 22: 62-68
        • Dorn SD
        • Meek PD
        • Shah ND
        Increasing frequency of opioid prescriptions for chronic abdominal pain in US outpatient clinics.
        Clin Gastroenterol Hepatol. 2011; 9: 1078-1085
        • Dorner TE
        • Muckenhuber J
        • Stronegger WJ
        • Ràsky E
        • Gustorff B
        • Freidl W
        The impact of socio-economic status on pain and the perception of disability due to pain.
        Eur J Pain. 2011; 15: 103-109
        • Feinberg T
        • Lilly C
        • Innes K
        Nonvitamin, nonmineral dietary supplement Use among adults with fibromyalgia: United States, 2007–2012.
        Evid Based Complement Alternat Med. 2017; 20176751856
        • Feuerstein M
        • Marcus SC
        • Huang GD
        National trends in nonoperative care for nonspecific back pain.
        Spine J. 2004; 4: 56-63
        • Fine M
        Quantifying the impact of NSAID-associated adverse events.
        Am J Manag Care. 2013; 19: s267-s272
        • Fischer B
        • Jones W
        • Rehm J
        Trends and changes in prescription opioid analgesic dispensing in Canada 2005-2012: An update with a focus on recent interventions.
        BMC Health Serv Res. 2014; 14: 90
        • Freburger JK
        • Holmes GM
        • Agans RP
        • Jackman AM
        • Darter JD
        • Wallace AS
        • Castel LD
        • Kalsbeek WD
        • Carey TS
        The rising prevalence of chronic low back pain.
        Arch Intern Med. 2009; 169: 251-258
        • Frenk SM
        • Porter KS
        • Paulozzi LJ
        Prescription opioid analgesic use among adults: United States, 1999-2012.
        NCHS Data Brief. 2015; 189: 1-8
        • Fuentes M
        • Hart-Johnson T
        • Green CR
        The association among neighborhood socioeconomic status, race and chronic pain in black and white older adults.
        J Natl Med Assoc. 2007; 99: 1160-1169
        • Gaskin DJ
        • Richard P
        The economic costs of pain in the United States.
        J Pain. 2012; 13: 715-724
        • Gibson JN
        • Waddell G
        Surgery for degenerative lumbar spondylosis: Updated Cochrane review.
        Spine. 2005; 30: 2312-2320
        • Hamunen K
        • Paakkari P
        • Kalso E
        Trends in opioid consumption in the Nordic countries 2002-2006.
        Eur J Pain. 2009; 13: 954-962
        • Institute of Medicine
        Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research.
        The National Academies Press, Washington, DC2011
        • Kantor ED
        • Rehm CD
        • Haas JS
        • Chan AT
        • Giovannucci EL
        Trends in prescription drug use among adults in the United States from 1999-2012.
        JAMA. 2015; 314: 1818-1831
        • Keeratisiroj O
        • Siritaratiwat W
        Prevalence of self-reported musculoskeletal pain symptoms among school-age adolescents: Age and sex differences.
        Scand J Pain. 2018; 18: 273-280
        • Kurita GP
        • Sjøgren P
        • Juel K
        • Højsted J
        • Ekholm O
        The burden of chronic pain: A cross-sectional survey focussing on diseases, immigration, and opioid use.
        Pain. 2012; 153: 2332-2338
        • Larochelle MR
        • Zhang F
        • Ross-Degnan D
        • Wharam JF
        Trends in opioid prescribing and co-prescribing of sedative hypnotics for acute and chronic musculoskeletal pain: 2001-2010.
        Pharmacoepidemiol Drug Saf. 2015; 24: 885-892
        • Laupattarakasem W
        • Laopaiboon M
        • Laupattarakasem P
        • Sumananont C
        Arthroscopic debridement for knee osteoarthritis.
        Cochrane Database Syst Rev. 2008; 1CD005118
        • Lerman SF
        • Rudich Z
        • Brill S
        • Shalev H
        • Shahar G
        Longitudinal associations between depression, anxiety, pain, and pain-related disability in chronic pain patients.
        Psychosom Med. 2015; 77: 333-341
        • Mafi JN
        • McCarthy EP
        • Davis RB
        • Landon BE
        Worsening trends in the management and treatment of back pain.
        JAMA Intern Med. 2013; 173: 1573-1581
        • Makris UE
        • Higashi RT
        • Marks EG
        • Fraenkel L
        • Sale JE
        • Gill TM
        • Reid MC
        Ageism, negative attitudes, and competing co-morbidities–Why older adults may not seek care for restricting back pain: A qualitative study.
        BMC Geriatr. 2015; 15: 39
        • Martin BI
        • Turner JA
        • Mirza SK
        • Lee MJ
        • Comstock BA
        • Deyo RA
        Trends in health care expenditures, utilization, and health status among US adults with spine problems, 1997-2006.
        Spine. 2009; 34: 2077-2084
        • McCrory DC
        • Turner DA
        • Patwardhan MB
        • Richardson WJ
        Spinal Fusion for Treatment of Degenerative Disease Affecting the Lumbar Spine [Internet].
        Agency for Healthcare Research and Quality (US), Rockville, MD2006 (Available at:)
        www.ncbi.nlm.nih.gov/books/NBK299153/
        Date accessed: July 5, 2018
        • Moore A
        • Bjarnason I
        • Cryer B
        • Garcia-Rodriguez L
        • Goldkind L
        • Lanas A
        • Simon L
        Evidence for endoscopic ulcers as meaningful surrogate endpoint for clinically significant upper gastrointestinal harm.
        Clin Gastroenterol Hepatol. 2009; 7: 1156-1163
        • Nahin RL
        Estimates of pain prevalence and severity in adults: United States, 2012.
        J Pain. 2015; 16: 769-780
        • Nahin RL
        • Stussman BJ
        • Herman PM
        Out-of-pocket expenditures on complementary health approaches associated with painful health conditions in a nationally representative adult sample.
        J Pain. 2015; 16: 1147-1162
        • Nguyen US
        • Zhang Y
        • Zhu Y
        • Niu J
        • Zhang B
        • Felson DT
        Increasing prevalence of knee pain and symptomatic knee osteoarthritis: Survey and cohort data.
        Ann Intern Med. 2011; 155: 725-732
        • Nuckols TK
        • Anderson L
        • Popescu I
        • Diamant AL
        • Doyle B
        • Di Capua P
        • Chou R
        Opioid prescribing: A systematic review and critical appraisal of guidelines for chronic pain.
        Ann Intern Med. 2014; 160: 38-47
      3. Office of Disease Prevention and Promotion: US Department of Health and Human Services. Healthy People 2020. Arthritis, osteoporosis and chronic back conditions. Available at: https://www.healthypeople.gov/2020/topics-objectives/topic/Arthritis-Osteoporosis-and-Chronic-Back-Conditions. Accessed July 7, 2018

        • Olsen Y
        • Daumit GL
        • Ford DE
        Opioid prescriptions by U.S. primary care physicians from 1992 to 2001.
        J Pain. 2006; 7: 225-235
        • Penney LS
        • Ritenbaugh C
        • DeBar LL
        • Elder C
        • Deyo RA
        Provider and patient perspectives on opioids and alternative treatments for managing chronic pain: A qualitative study.
        BMC Fam Pract. 2017; 17: 164
      4. Phurrough S, Norris A, Feinglass S, Carino T, Schott L. CMS Decision Memo for Arthroscopy for the Osteoarthritic Knee. Available at: https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=7&fromdb=true. Accessed on January 30, 2019

        • Pletcher MJ
        • Kertesz SG
        • Kohn MA
        • Gonzales R
        Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments.
        JAMA. 2008; 299: 70-78
        • Przekop P
        • Haviland MG
        • Oda K
        • Morton KR
        Prevalence and correlates of pain interference in older adults: Why treating the whole body and mind is necessary.
        J Bodyw Mov Ther. 2015; 19: 217-225
        • Richardson LP
        • Fan MY
        • McCarty CA
        • Katon W
        • Edlund M
        • DeVries A
        • Martin BC
        • Sullivan M
        Trends in the prescription of opioids for adolescents with non-cancer pain.
        Gen Hosp Psychiatry. 2011; 33: 423-428
        • Rios R
        • Zautra AJ
        Socioeconomic disparities in pain: The role of economic hardship and daily financial worry.
        Health Psychol. 2011; 30: 58-66
        • Roth RS
        • Punch MR
        • Bachman JE
        Educational achievement and pain disability among women with chronic pelvic pain.
        J Psychosom Res. 2001; 51: 563-569
        • Rutkow L
        • Vernick JS
        • Alexander GC
        More states should regulate pain management clinics to promote public health.
        Am J Public Health. 2017; 10: 240-243
      5. Shield KD, Jones W, Rehm J, Fischer B: Use and nonmedical use of prescription opioid analgesics in the general population of Canada and correlations with dispensing levels in 2009. Pain Res Manag 18:69-74, 2013

        • Smith M
        • Davis MA
        • Stano M
        • Whedon JM
        Aging baby boomers and the rising cost of chronic back pain: Secular trend analysis of longitudinal Medical Expenditures Panel Survey data for years 2000 to 2007.
        J Manipulative Physiol Ther. 2013; 36: 2-11
        • Spitz A
        • Moore AA
        • Papaleontiou M
        • Granieri E
        • Turner BJ
        • Reid MC
        Primary care providers' perspective on prescribing opioids to older adults with chronic non-cancer pain: A qualitative study.
        BMC Geriatr. 2011; 11: 35
        • Steinman MA
        • Komaiko KD
        • Fung KZ
        • Ritchie CS
        Use of opioids and other analgesics by older adults in the United States, 1999-2010.
        Pain Med. 2015; 16: 319-327
        • Stockbridge EL
        • Suzuki S
        • Pagán JA
        Chronic pain and health care spending: An analysis of longitudinal data from the Medical Expenditure Panel Survey.
        Health Serv Res. 2015; 50: 847-870
        • Strate LL
        • Liu YL
        • Huang ES
        • Giovannucci EL
        • Chan AT
        Use of aspirin or nonsteroidal anti-inflammatory drugs increases risk for diverticulitis and diverticular bleeding.
        Gastroenterology. 2011; 140: 1427-1433
        • Sturm R
        • Cohen DA
        Suburban sprawl and physical and mental health.
        Public Health. 2004; 118: 488-496
        • Toblin RL
        • Mack KA
        • Perveen G
        • Paulozzi LJ
        A population-based survey of chronic pain and its treatment with prescription drugs.
        Pain. 2011; 152: 1249-1255
        • Valkhoff VE
        • Sturkenboom MC
        • Hill C
        • Veldhuyzen van Zanten S
        • Kuipers EJ
        Low-dose acetylsalicylic acid use and the risk of upper gastrointestinal bleeding: A meta-analysis of randomized clinical trials and observational studies.
        Can J Gastroenterol. 2013; 27: 159-167
        • Vallerand A
        • Nowak L
        Chronic opioid therapy for nonmalignant pain: The patient's perspective. Part I–life before and after opioid therapy.
        Pain Manag Nurs. 2009; 10: 165-172
        • Vallerand A
        • Nowak L
        Chronic opioid therapy for nonmalignant pain: The patient's perspective. Part II–Barriers to chronic opioid therapy.
        Pain Manag Nurs. 2010; 11: 126-131
        • van Tulder MW
        • Koes B
        • Seitsalo S
        • Malmivaara A
        Outcome of invasive treatment modalities on back pain and sciatica: An evidence-based review.
        Eur Spine J. 2006; 15: S82-S92
        • Van Zee A
        The promotion and marketing of oxycontin: Commercial triumph, public health tragedy.
        Am J Public Health. 2009; 99: 221-227
        • Vandegrift D.
        • Yoked T.
        Obesity rates, income, and suburban sprawl: An analysis of US states.
        Health Place. 2004; 10: 221-229
        • Weinberger AH
        • A
        • Gbedemah M.
        • Martinez A.
        • Nash D.
        • Galea S.
        • Goodwin R
        Trends in depression prevalence in the USA from 2005 to 2015: Widening disparities in vulnerable groups.
        Psychol Med. 2017; 48: 1308-1315
        • Western B
        • Bloome D
        • Sosnaud B
        • Tach LM
        Economic Insecurity and Social Stratification.
        Ann Rev Sociology. 2012; 38: 341-359
        • Western B
        • Bloome D
        • Sosnaud B
        • Tach LM
        Trends in income insecurity among U.S. children, 1984–2010.
        Demography. 2016; 53: 419-447
        • Wilson RD
        Analgesic prescribing for musculoskeletal complaints in the ambulatory care setting after the introduction and withdrawal of cyclooxygenase-2 inhibitors.
        Arch Phys Med Rehabil. 2009; 90: 1147-1151
        • Wright EA
        • Katz JN
        • Abrams S
        • Solomon DH
        • Losina E
        Trends in prescription of opioids from 2003-2009 in persons with knee osteoarthritis.
        Arthritis Care Res (Hoboken). 2014; 66: 1489-1495
        • Yelin E
        • Murphy L
        • Cisternas MG
        • Foreman AJ
        • Pasta DJ
        • Helmick CG
        Medical care expenditures and earnings losses among persons with arthritis and other rheumatic conditions in 2003, and comparisons with 1997.
        Arthritis Rheum. 2007; 56: 1397-1407