Pain Treated More With Opioids, Less With Physical Therapy, During COVID-19 Pandemic

Opioid prescriptions for chronic pain have increased during the COVID-19 pandemic as the use of physical therapy – a low-risk alternative treatment for pain management – has declined, according to a study published in December 2021 in JAMA network open.

To examine changes in the treatment of chronic pain, researchers looked at data on private health insurance claims from more than 24 million Americans. They focused on three distinct phases of the pandemic in 2020: the pre-pandemic period, before a national emergency was declared on March 13; the start of the pandemic period, with widespread home stay orders, which ran until July 4; and a late pandemic period, after life reopened in many places, which lasted until September 30. They compared the prevalence of pain diagnoses and treatments in each of these three pandemic periods of 2020 with the same periods in 2019.

At the start of the pandemic period, when life came to a standstill in many ways, the proportion of patients with diagnoses of chronic pain, such as back, neck or joint pain, declined by about 16% per year. compared to the same period in 2019. During the At the start of the pandemic period, the proportion of patients with chronic pain who received opioids increased by 3.5% and the proportion of patients who received physical therapy or d other non-drug treatments fell 6%.

Even more troubling, people on opioids at the start of the pandemic stayed on these drugs longer and took larger doses than during the same weeks of 2019.

“Before the COVID-19 pandemic, opioid prescriptions were dropping and physical therapy use was on the rise,” says study lead author Byungkyu Lee, PhD, assistant professor of sociology at Indiana University in Bloomington.

“We show that the pandemic may have reversed these trends, especially during the early stages of the epidemic,” Dr Lee said.

Opioid overdose deaths skyrocket

Although the study did not focus on opioid abuse, it is possible that the increased dependence on these drugs by pain patients indirectly contributed to the record increase in opioid overdose deaths during pandemic, says Lee.

Late last year, the Centers for Disease Control and Prevention (CDC) reported that there had been more than 83,000 drug overdose deaths in the 12 months ending May 2020, a record high at the era that was fueled in large part by a 38.4% increase in deaths from synthetic opioids and illegally manufactured fentanyl.

This trend shows no signs of slowing down. In November 2021, the CDC reported that more than 100,000 people died of drug overdoses in the 12 months ending in April 2021, shattering a previous record for the most deaths on record in a period of one. year. The majority of these deaths – 76,056 – were due to opioid overdoses.

In theory, people who managed pain with opioids earlier in the pandemic might be able to start or resume physical therapy as an alternative now, Lee says. But many people who lost their jobs or income during the pandemic may still struggle to afford or access care.

“Many patients will continue to be unable to benefit from non-pharmacological treatment due to issues such as cost, underinsurance, lack of transportation, childcare or inability to take time off work. Says Lee. “These barriers disproportionately affect people in rural areas, black and Latin patients, gender and sex minorities, and people from disadvantaged socio-economic groups and thus may contribute to wider disparities in disorders. related to opioid use and overdoses. “

There is a growing trend away from PT to treat pain

One limitation of the study is that it only focused on people with private health insurance, and the results may not apply to people who are uninsured or covered by government health programs. like Medicaid. Another downside is that the data on opioid use was based on the prescriptions people filled, which didn’t necessarily reflect the number of pills they actually took.

The study was also not designed to determine why clinicians may have prescribed opioids or physical therapy to individual patients, making it difficult to know how much of this was influenced by changes in l. ‘extent of pain or disability experienced by patients or by other factors, says Harlan Krumholz, MD, a professor at Yale University School of Medicine in New Haven, Connecticut, who has studied patterns of abuse. opioids.

“The pressures on the system in 2021 have not decreased compared to 2020,” said Dr Krumholz. “And if this is the result of the propensity of clinicians to prescribe opioids, then we need more work to determine why this has happened and the long-term impact on populations.”

The results of the current study earlier reflect the documentation of a move away from physical therapy and other alternative treatments for pain management during the pandemic. A study, published in February 2021 in the Journal of the American Board of Family Medicine, for example, followed 528 patients with chronic back pain in Texas, and they were half as likely to use physiotherapy or massage therapy to manage pain during the pandemic than before.

As the pandemic progressed – and stay-at-home orders were lifted along with some limits on in-person medical care – the current study found a slight drop in opioid prescribing and a slight increase in opioid prescribing. the use of physical therapy for chronic pain.

“This suggests that opioid prescriptions were used as a stopgap in an era when nonpharmacologic therapies were not available,” says Danielle Haley, MPH, PhD, assistant professor of community health services at the Boston University School of Public Health in Massachusetts, who was not involved in the study.

Completely reversing the pandemic trend towards greater opioid use and less reliance on physical therapy or other alternatives to manage chronic pain will always be difficult, says Krumholz.

“Our history with opioids tells us it’s hard to turn the tide,” Krumholz said. “Patients and their clinicians have found it far too easy to use opioids and far too difficult to quit. “

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