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What proportion of patients with chronic non cancer pain are prescribed an opioid medicine? Systematic review and meta-regression of observational studies
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Mathieson, S., Wertheimer, G., Maher, C. G., Lin, C -W. Christine, McLachlan, A. J., Buchbinder, R., Peason, S -A. and Underwood, Martin (2020) What proportion of patients with chronic non cancer pain are prescribed an opioid medicine? Systematic review and meta-regression of observational studies. Journal of Internal Medicine, 287 (5). pp. 458-474. doi:10. 1111/joim.13026
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Official URL: https://doi.org/10. 1111/joim.13026
Abstract
Guidelines now discourage opioid analgesics for chronic noncancer pain because the benefits frequently do not outweigh the harms. We aimed to determine the proportion of patients with chronic noncancer pain who are prescribed an opioid, the types prescribed and factors associated with prescribing. Database searches were conducted from inception to 29 October 2018 without language restrictions. We included observational studies of adults with chronic noncancer pain measuring opioid prescribing. Opioids were categorized as weak (e.g. codeine) or strong (e.g. oxycodone). Study quality was assessed using a risk of bias tool designed for observational studies measuring prevalence. Individual study results were pooled using a random‐effects model. Meta‐regression investigated study‐level factors associated with prescribing (e.g. sampling year, geographic region as per World Health Organization). The overall evidence quality was assessed using Grading of Recommendations Assessment, Development and Evaluation criteria. Of the 42 studies (5,059,098 participants) identified, the majority (n = 28) were from the United States of America. Eleven studies were at low risk of bias. The pooled estimate of the proportion of patients with chronic noncancer pain prescribed opioids was 30.7% (95% CI 28.7% to 32.7%, n = 42 studies, moderate‐quality evidence). Strong opioids were more frequently prescribed than weak (18.4% (95% CI 16.0–21.0%, n = 15 studies, low‐quality evidence), versus 8.5% (95% CI 7.2–9.9%, n = 15 studies, low‐quality evidence)). Meta‐regression determined that opioid prescribing was associated with year of sampling (more prescribing in recent years) (P = 0.014) and not geographic region (P = 0.056). Opioid prescribing for patients with chronic noncancer pain is common and has increased over time.
| Item Type: | Journal Article | |||||||||||||||
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| Subjects: | R Medicine > RB Pathology R Medicine > RC Internal medicine |
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| Divisions: | Faculty of Medicine > Warwick Medical School > Health Sciences > Clinical Trials Unit Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Opioids , Chronic pain, Chronic pain -- Treatment, Opioids -- Therapeutic use | |||||||||||||||
| Journal or Publication Title: | Journal of Internal Medicine | |||||||||||||||
| Publisher: | Wiley-Blackwell Publishing Ltd. | |||||||||||||||
| ISSN: | 0954-6820 | |||||||||||||||
| Official Date: | May 2020 | |||||||||||||||
| Dates: |
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| Date of first compliant deposit: | 12 February 2020 | |||||||||||||||
| Volume: | 287 | |||||||||||||||
| Number: | 5 | |||||||||||||||
| Page Range: | pp. 458-474 | |||||||||||||||
| DOI: | 10. 1111/joim.13026 | |||||||||||||||
| Status: | Peer Reviewed | |||||||||||||||
| Publication Status: | Published | |||||||||||||||
| Publisher Statement: | "This is the peer reviewed version of the following article: Mathieson, S, Wertheimer, G, Maher, CG, Lin, C‐WC, McLachlan, AJ, Buchbinder, R, Pearson, S‐A, Underwood, M (Institute for Musculoskeletal Health; The University of Sydney, Sydney, NSW; University of Notre Dame, IN; Cabrini Institute, Malvern; Monash University, Melbourne, Vic.; University of New South Wales, Sydney, NSW, Australia; University of Warwick, Coventry; University Hospitals of Coventry and Warwickshire, Coventry, UK). What proportion of patients with chronic noncancer pain are prescribed an opioid medicine? Systematic review and meta‐regression of observational studies (Review). J Intern Med 2020; 287: 458– 474., which has been published in final form at https://doi.org/10.1111/joim.13026. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions." | |||||||||||||||
| Access rights to Published version: | Restricted or Subscription Access | |||||||||||||||
| Description: | Free access |
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