title: Ambulatory diagnosis and treatment of nonmalignant pain in the United States, 2000-2010.
abstract: BACKGROUND
  Escalating rates of prescription opioid use and abuse have occurred in the context of efforts to improve the treatment of nonmalignant pain.
  
  
  OBJECTIVE
  The aim of the study was to characterize the diagnosis and management of nonmalignant pain in ambulatory, office-based settings in the United States between 2000 and 2010.
  
  
  METHODS
  Serial cross-sectional and multivariate regression analyses of the National Ambulatory Medical Care Survey (NAMCS), a nationally representative audit of office-based physician visits, were conducted.
  
  
  METHODS
  (1) Annual visit volume among adults with primary pain symptom or diagnosis; (2) receipt of any pain treatment; and (3) receipt of prescription opioid or nonopioid pharmacologic therapy in visits for new musculoskeletal pain.
  
  
  RESULTS
  Primary symptoms or diagnoses of pain consistently represented one-fifth of visits, varying little from 2000 to 2010. Among all pain visits, opioid prescribing nearly doubled from 11.3% to 19.6%, whereas nonopioid analgesic prescribing remained unchanged (26%-29% of visits). One-half of new musculoskeletal pain visits resulted in pharmacologic treatment, although the prescribing of nonopioid pharmacotherapies decreased from 38% of visits (2000) to 29% of visits (2010). After adjusting for potentially confounding covariates, few patient, physician, or practice characteristics were associated with a prescription opioid rather than a nonopioid analgesic for new musculoskeletal pain, and increases in opioid prescribing generally occurred nonselectively over time.
  
  
  CONCLUSIONS
  Increased opioid prescribing has not been accompanied by similar increases in nonopioid analgesics or the proportion of ambulatory pain patients receiving pharmacologic treatment. Clinical alternatives to prescription opioids may be underutilized as a means of treating ambulatory nonmalignant pain.
authors.affiliation: *Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health †Center for Drug Safety and Effectiveness, Johns Hopkins University ‡Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD §Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN ∥Program on Prevention Outcomes and Practices, Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, CA ¶Stefan P. Kruszewski, MD & Associates, Harrisburg, PA #Department of Mental Health, Johns Hopkins Bloomberg School of Public Health **Department of Medicine, Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, MD.
authors.forename: Matthew
authors.initials: M
authors.lastname: Daubresse
authors.forename: Hsien-Yen
authors.initials: HY
authors.lastname: Chang
authors.forename: Yuping
authors.initials: Y
authors.lastname: Yu
authors.forename: Shilpa
authors.initials: S
authors.lastname: Viswanathan
authors.forename: Nilay D
authors.initials: ND
authors.lastname: Shah
authors.forename: Randall S
authors.initials: RS
authors.lastname: Stafford
authors.forename: Stefan P
authors.initials: SP
authors.lastname: Kruszewski
authors.forename: G Caleb
authors.initials: GC
authors.lastname: Alexander
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009819:Office Visits / Q000706:statistics & numerical data; D010146:Pain / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D010818:Practice Patterns, Physicians'; D055553:Prescription Drugs / Q000627:therapeutic use*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D055553:Prescription Drugs
references.citation: CMAJ. 2006 May 23;174(11):1589-94
references.pmid: 16717269
references.citation: Pain. 2004 Jun;109(3):514-519
references.pmid: 15157714
references.citation: J Am Coll Surg. 2007 Jul;205(1):101-7
references.pmid: 17617339
references.citation: JAMA. 1995 Dec 20;274(23):1874-80
references.pmid: 7500539
references.citation: MMWR Morb Mortal Wkly Rep. 2011 Nov 4;60(43):1487-92
references.pmid: 22048730
references.citation: Case Manager. 2000 Sep-Oct;11(5):50-3
references.pmid: 11942280
references.citation: Ann Intern Med. 2007 Jan 16;146(2):116-27
references.pmid: 17227935
references.citation: Circulation. 2000 Mar 14;101(10):1097-101
references.pmid: 10715254
references.citation: Postgrad Med. 2011 Mar;123(2):119-30
references.pmid: 21474900
references.citation: NCHS Data Brief. 2011 Dec;(81):1-8
references.pmid: 22617462
references.citation: J Pain Symptom Manage. 2003 Nov;26(5):1026-48
references.pmid: 14585554
references.citation: Pain. 2008 Aug 31;138(2):440-449
references.pmid: 18547726
references.citation: J Gen Intern Med. 2006 Jun;21(6):607-12
references.pmid: 16808744
references.citation: Lancet. 2011 Jun 25;377(9784):2226-35
references.pmid: 21704872
references.citation: Pain Physician. 2010 Sep-Oct;13(5):401-35
references.pmid: 20859312
references.citation: Eur J Pain. 2003;7(5):381-6
references.pmid: 12935789
references.citation: JAMA. 2009 Jun 17;301(23):2488-90
references.pmid: 19531789
references.citation: J Pain. 2006 Apr;7(4):225-35
references.pmid: 16618466
references.citation: Pain Physician. 2008 Mar;11(2 Suppl):S63-88
references.pmid: 18443641
references.citation: JAMA. 2012 Nov 14;308(18):1865-6
references.pmid: 23150006
references.citation: Natl Health Stat Report. 2010 Nov 3;(27):1-32
references.pmid: 21089986
references.citation: Ann Emerg Med. 2008 Dec;52(6):689-95
references.pmid: 18501475
references.citation: Arch Intern Med. 2011 Sep 12;171(16):1426-7
references.pmid: 21670333
references.citation: J Am Board Fam Med. 2009 May-Jun;22(3):291-8
references.pmid: 19429735