title: Office visits and analgesic prescriptions for musculoskeletal pain in US: 1980 vs. 2000.
abstract: The treatment of pain has received increasing attention over the past decade promoted by national guidelines, the 'pain as the 5th vital sign' campaign and direct-to-consumer advertising. We examined national trends in office visits and analgesic treatment for musculoskeletal pain in the office setting, comparing data from 1980 and 2000. We analysed the National Ambulatory Medical Care Survey (NAMCS)--a nationally representative survey of visits to office-based physicians--using data from 1980-81 (n=89,000 visits) and 1999-2000 (n=45,000 visits). During this time, NSAID prescriptions increased for both acute (19 vs. 33%, RR=1.74; 95% CI, 1.52-1.95) and chronic (25 vs. 29%, RR=1.16; 95% CI, 0.97-1.35) musculoskeletal pain visits. In 2000, one-third of the NSAID prescriptions were for COX II agents. Opioids increased for acute pain (8 vs. 11%, RR=1.38; 95% CI, 0.92-1.83) and doubled for chronic pain (8 vs. 16%, RR=2.0; 95% CI, 1.52-2.48). The use of more potent opioids (hydrocodone, oxycodone, morphine) for chronic musculoskeletal pain increased from 2 to 9% of visits (RR=4.5; 95% CI, 2.18-6.87). This corresponds to 5.9 million visits where potent opioids were prescribed in 2000--an increase of 4.6 million visits from 1980 (assuming the total number of outpatient visits was constant at the 2000 level). In spite of the increased attention to pain treatment, there has not been an increase in office visits for musculoskeletal pain complaints. The threshold for prescribing NSAIDS and opioids, however, has dropped.
authors.affiliation: VA Outcomes Group and VA Quality Scholars Program (11Q), Department of Veterans Affairs Medical Center, Dartmouth Medical School, 215 North Main St., White River Junction, VT 05009-001, USA Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, NH, USA.
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Caudill-Slosberg
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Schwartz
authors.forename: Steven
authors.initials: S
authors.lastname: Woloshin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia / Q000706:statistics & numerical data*; D000700:Analgesics / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D002908:Chronic Disease; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D019538:Health Care Surveys; D049673:History, 20th Century; D006801:Humans; D008297:Male; D008511:Medicine / Q000706:statistics & numerical data / Q000639:trends; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000188:drug therapy* / Q000523:psychology; D009819:Office Visits / Q000706:statistics & numerical data* / Q000639:trends; D010146:Pain / Q000188:drug therapy* / Q000523:psychology; D013038:Specialization; D014481:United States
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000927:Anticonvulsants; D000929:Antidepressive Agents, Tricyclic