title: Association between pain outcomes and race and opioid treatment: Retrospective cohort study of Veterans.
abstract: We examined whether pain outcomes (pain interference, perceived pain treatment effectiveness) vary by race and then whether opioid use moderates these associations. These analyses are part of a retrospective cohort study among 3,505 black and 46,203 non-Hispanic, white Department of Veterans Affairs (VA) patients with diagnoses of chronic musculoskeletal pain who responded to the 2007 VA Survey of Healthcare Experiences of Patients (SHEP). We used electronic medical record data to identify prescriptions for pharmacologic pain treatments in the year after diagnosis (Pain Diagnosis index visit) and before the SHEP index visit (the visit that made one eligible to complete the SHEP); pain outcomes came from the SHEP. We found no significant associations between race and pain interference or perceived effectiveness of pain treatment. VA patients with opioid prescriptions between the Pain Diagnosis index visit and the SHEP index visit reported greater pain interference on the SHEP than those without opioid prescriptions during that period. Opioid prescriptions were not associated with perceived treatment effectiveness for most patients. Findings raise questions about benefits of opioids for musculoskeletal pain and point to the need for alternative treatments for addressing chronic noncancer pain.
authors.affiliation: Center for Chronic Disease Outcomes Research, Minneapolis Department of Veterans Affairs (VA) Health Care System, Minneapolis, MN.
authors.forename: Diana J
authors.initials: DJ
authors.lastname: Burgess
authors.forename: Amy A
authors.initials: AA
authors.lastname: Gravely
authors.forename: David B
authors.initials: DB
authors.lastname: Nelson
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Bair
authors.forename: Robert D
authors.initials: RD
authors.lastname: Kerns
authors.forename: Diana M
authors.initials: DM
authors.lastname: Higgins
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Farmer
authors.forename: Melissa R
authors.initials: MR
authors.lastname: Partin
mesh_terms: D001741:Black or African American; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D059350:Chronic Pain / Q000188:drug therapy* / Q000208:ethnology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D059408:Pain Management / Q000379:methods*; D011159:Population Surveillance; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data; D014728:Veterans / Q000706:statistics & numerical data*; D044465:White People
chemical_list: D000701:Analgesics, Opioid
keywords: Department of Veterans Affairs; Veterans; blacks; chronic pain; disparities; opioids; pain outcomes; pain treatment effectiveness; race; survey