Trends in Opioids and Non-Pharmacologic Pain Management among U.S. Cancer Survivors, 2011-2020.

Abstract

It is unknown how the U.S. opioid epidemic influenced the integration of nonpharmacologic pain treatments in cancer survivors. We described annual trends and predictors of using opioids alone, nonpharmacologic treatments alone, multimodal (opioid + nonpharmacologic), and neither treatment. A serial cross-sectional design. Ambulatory. Non-institutionalized U.S. adults with prevalent cancer and pain in the Medical Expenditure Panel Survey (2011-2020). N/A. Period prevalence of self-reported and pharmacy-verified use of opioids alone, nonpharmacologic treatments alone, both, or neither. Nonpharmacologic treatments included physical therapy, occupational therapy, chiropractic care, massage therapy and acupuncture. Respondents with cancer and pain represented a total of 41,064,668 adults from 2011-2020. Most adults with cancer pain were >65 years of age (66.6%), female (52.1%), white (91.4%), non-Hispanic (95.8%), had a high school diploma (42.2%), income 400% of the federal poverty line (46.6%) and lived in the U.S. South (37.7%). Compared to 2011, the prevalence of multimodal treatments increased from 4% (95% CI, 2%-6%) to 10% (6%-14%) in 2019, while using neither pain treatment decreased from 62% (55%-68%) to 46% (40%-52%). Compared to using neither treatment, the adjusted relative risk ratio (RR) of using nonpharmacologic treatments treatment was stable from 2011-2015 (RR: 1.00; [95% CI, 0.93-1.08], but increased from 2016-2019 (RR: 1.22; [95% CI, 1.02-1.46]) until 2020 (RR: 0.68; [0.43-1.46]). Both unadjusted and adjusted analyses found pain treatments varied based on income, educational attainment, race, and geographic region. Nonpharmacologic and multimodal pain treatments increased from 2011 to 2020; however, most cancer pain survivors remained untreated. Pain treatment varied on sociodemographic and socioeconomic factors.