Use of non-opioid and non-drug treatment for chronic pain: trends and relationships with opioid prescribing and outcomes in Rhode Island All Payer Claims Data

Former Pilot Project Awardee
1/1/2019 – 12/31/2020

Patience Moyo, PhD

Patience Moyo, PhD

Assistant Professor of Health Services, Policy and Practice

Brown University

Tel: 401-863-9220

Although prescription opioids have great utility for managing acute pain, there is inadequate support for their use and effectiveness to treat chronic pain. The rationale for this study is that the uptake of non-opioid and non-pharmacologic pain therapy is poorly understood but is increasingly important to comprehend amid national and state trends of declining levels of opioid prescribing and clinical practice guidelines calling for more comprehensive modalities to treat chronic non-cancer pain. The objective of the proposed project is to describe prescription opioid, non-opioid and non-pharmacologic treatments and evaluate health outcomes among chronic pain patients enrolled in public and private plans in Rhode Island. To achieve these research goals, we propose a retrospective analysis of 2011-2017 All Payer Claims Data (RI APCD) which captures enrollment, pharmacy, hospital, and outpatient claims as well as select provider information (e.g., specialty). The Specific Aims are to: 1. Characterize patterns of opioid prescribing, use of non-opioid prescription medications, and non-pharmacologic options for chronic pain management. Hypothesis: The rates and intensity of long-term opioid use will decrease, use of non-opioid medications (gabapentin and pregabalin) will increase moderately, whereas there will be marginal or no change in use of non-pharmacologic treatments (physical therapy and chiropractic care). 2. Compare patterns of prescribed opioid use, rates of opioid use disorder, and opioid-related hospitalizations or emergency department visits among those who did and did not receive non-opioid or non-pharmacologic pain therapies. Hypothesis: Receipt of non-drug and non-pharmacologic pain treatment will be associated with lower duration and dose of opioid use, and fewer opioid related health service use encounters. The long-term goal of this research is to develop the empirical evidence base needed to promote comprehensive clinical management of chronic pain with or without opioids, and inform policymaking that helps reduce barriers to accessing diverse treatment modalities for chronic pain.