Most non-cancer pain opioid prescriptions are for musculoskeletal conditions, study finds

Nearly three quarters of new non-cancer pain opioid prescriptions were for patients with musculoskeletal conditions, despite limited evidence of the drug's efficacy, according to the largest U.K. study of its kind.

The new study evaluated the specific clinical conditions that lead to the initiation of opioid prescriptions using data from nationally representative GP electronic health records.

The study team from The University of Manchester, The Northern care Alliance and the National Institute for Health and Care Research (NIHR) Manchester Biomedical Research Center (BRC) have published their results in the journal Pain.

The findings are published amid a backdrop of a considerable rise in opioid prescriptions over the past two decades. A 48.9% increase in opioid-related hospitalizations from 2008 to 2018 has also been reported, paralleled by an increase in opioid-related harm over two decades.

From a statistical evaluation of more than 2 million records of patients prescribed opioids for non-cancer pain, 61% were women and 77% were over 45 years old.

The researchers also discovered a pattern of opioid use for respiratory conditions such as cough, infections, trauma and injuries such as sprains and strains, neurological issues such as headaches, and post-surgical pain.

The most frequent musculoskeletal conditions were osteoarthritis and lower back pain.

The most common surgical indications were total knee and hip replacements, followed by hernia repairs.

In 2021, previous research has shown that opioids were involved in nearly half (2,219) of all U.K. drug poisoning deaths.

Organizations including the National Institute for Health and Care Excellence (NICE) and the Royal College of Anesthetists, currently suggest alternatives to weak opioids unless other types of pain relief are contraindicated.

Strong opioids are no longer recommended for osteoarthritis or chronic low back pain.

Joint first author of the study and research associate, Carlos Ramirez Medina from The University of Manchester said, "While our study does not aim to evaluate the appropriateness of opioid prescriptions, it uses nationally representative data to increase awareness of the possible reasons for opioid initiation in U.K. primary care and encourage a re-evaluation of prescribing practices."

Senior author of the paper is Dr. Meghna Jani, an NIHR Advanced fellow and Senior Clinical Lecturer at The University of Manchester, Consultant Rheumatologist at Salford Royal Hospital.

She said, "Our study indicates that opioids are commonly prescribed in patients with musculoskeletal conditions, despite scientific evidence suggesting limited effectiveness, especially in conditions such as osteoarthritis.

"For chronic lower back pain and osteoarthritis in particular, the ongoing prescription of opioids may suggest a complex landscape of pain management given limited drug treatment options for these conditions and access to helpful interventions such as physiotherapy.

"The increasing proportion of opioid use in musculoskeletal conditions over time in our study may also be reflective of an aging population who are more at risk of developing conditions such as osteoarthritis and chronic low back pain.

"Making informed shared decisions between health care professionals and patients is especially important, especially in such groups where opioids may cause more harm due to side effects and interactions with other medicines."

Primary care electronic health records from January 2006 to September 2021 were used from the Clinical Research Practice Datalink (CPRD) to identify opioid prescriptions.

She added, "We hope these findings will help inform targeted interventions in specific disease areas and future policies to support non-pharmacological interventions in the most common conditions where opioid associated harms outweigh benefits."