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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Article info
Publication history
Published online: January 15, 2019
Accepted:
January 7,
2019
Received in revised form:
November 9,
2018
Received:
August 23,
2018
Footnotes
RLN, BJS, TF: No outside financial support was provided. The authors have no competing interests. BS worked as a federal contractor during the planning, analysis, and writing of this article, and performed this work as part of this contract.
Supplementary data accompanying this article are available online at www.jpain.org and www.sciencedirect.com.
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© Published by Elsevier Inc. on behalf of the American Pain Society
