Opioid use and social disadvantage in patients with chronic musculoskeletal pain.
Abby L Cheng, Brian K Brady, Ethan C Bradley and 4 others
PMID 33773068WHAT IT FOUND
Patients with chronic musculoskeletal pain on long-term opioids were more likely to live in socially disadvantaged areas and report worse depression, anxiety, and pain interference than patients not routinely prescribed opioids.
This is an association, not proof opioids caused disadvantage.
Key findings
01Patients managed with chronic opioid therapy were more likely to live in socially disadvantaged communities: 34.9% were in the worst ADI national quartile, compared with 24.9% of patients not on chronic opioid therapy.
02After adjustment, higher community disadvantage remained associated with chronic opioid therapy, with an odds ratio of 1.01 for each ADI national percentile.
03Chronic opioid therapy was independently associated with worse PROMIS Depression (3.8), Anxiety (3.0), and Pain Interference (2.6) scores on scales centered at 50.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
The study cannot show cause and effect because it compared groups at one time point. It was done at one academic physiatry practice, so results may not apply to other settings, including primary care. Data were collected retrospectively, and some records were missing, especially anxiety scores. The Area Deprivation Index describes neighborhoods, not individual patients, and was assigned from addresses between 2015 and 2017. There was no statewide prescription monitoring, so the researchers could not fully confirm that patients not on chronic opioids did not receive opioids elsewhere. Potential confounders such as number of pain sites, medical complexity, and healthcare utilization were not reliably available. Patients on chronic opioids likely had more frequent visits, while patients not on opioids may have pursued other treatments such as physical therapy, bracing, pain psychology, or procedures. Patients who did not meet opioid adherence rules were excluded from the main opioid group, so the main comparison describes adherent opioid users.
Declared interests
The supplied publication metadata lists NIH extramural research support. The provided article text does not include a detailed conflict-of-interest statement.
The easy way to misread this
Do not conclude that chronic opioid therapy caused social disadvantage or that tapering opioids will improve health. This was a cross-sectional comparison at one time point, and it cannot prove cause.