Doctronic

Understanding Opioid Overprescription for Chronic Musculoskeletal Pain

Alan Lucks | MD

Medically reviewed by Alan Lucks | MD, Alan Lucks MDPC Private Practice - New York on June 30th, 2024.

Key Takeaways

  • Between 2007-2015, 21.5% of first visits for chronic musculoskeletal pain resulted in opioid prescriptions, despite evidence showing minimal long-term benefits for non-cancer pain conditions.
  • Chronic opioid use (beyond 3 months) for back pain and arthritis shows no superior pain relief compared to non-opioid treatments like NSAIDs, but carries 40-50% higher risk of dependency.
  • Physical therapy combined with cognitive behavioral therapy reduces pain scores by 30-40% in chronic musculoskeletal conditions without addiction potential or respiratory depression risks.
  • Red flag prescribing practices include starting with long-acting opioids, prescribing more than 50 morphine milligram equivalents daily initially, or continuing opioids without functional improvement assessments.
  • Evidence-based first-line treatments include acetaminophen (up to 3000mg daily), topical NSAIDs for localized pain, and structured exercise programs that can reduce pain intensity by 25-35%.

Chronic musculoskeletal pain is a common condition that affects many people worldwide. Unfortunately, a study published in The Journal of Pain in December 2019 revealed that doctors have been overprescribing opioids for this type of pain, despite the known risks and the availability of safer alternatives.

The Study's Findings

Researchers analyzed data from a survey conducted between 2007 and 2015 and found that doctors more frequently prescribed pills, either non-opioid or opioid, rather than recommending other treatment options, such as:

  • Physical therapy

  • Counseling

  • Other nondrug interventions

At patients' first visits, doctors most often prescribed:

  1. Non-opioid painkillers (40.2%)

  2. Opioids (21.5%)

  3. Counseling, nonpharmacological treatments, and physical therapy

Understanding Opioid Overprescription for Chronic Musculoskeletal Pain

Consequences of Opioid Overprescription

The overprescription of opioids can lead to several serious consequences, including:

  • Increased risk of addiction

  • Overdose

  • Other health complications

The study's findings are particularly concerning because they directly contradict the recommendations of experts, including those outlined in the CDC Guideline for Prescribing Opioids for Chronic Pain.

Recommended Alternatives to Opioid Treatment

Instead of relying on opioids, experts recommend several alternative treatments for managing chronic musculoskeletal pain, such as:

  • Physical therapy

  • Counseling and behavioral therapy

  • Nondrug interventions (e.g., massage, acupuncture)

  • Non-opioid pain medications (e.g., acetaminophen, NSAIDs)

  • Creams/gels with pain meds and cannabis formulations can help with pain

The Need for Education and Awareness

The study authors emphasize the need for improved education among healthcare providers to ensure that patients receive the most appropriate and effective treatments for chronic musculoskeletal pain. It is important to note that the study period (2007-2015) preceded much of the recent work and advocacy aimed at reducing opioid prescriptions, so the situation may have improved since then.

By raising awareness about the risks of opioid overprescription and promoting safer alternatives, we can work towards better pain management and improved patient outcomes. If you are experiencing chronic musculoskeletal pain, talk to your doctor about the most appropriate treatment options for your individual needs and preferences.

The Bottom Line

Most chronic muscle and joint pain responds better to non-opioid treatments that don't carry addiction risks, yet many providers still prescribe opioids inappropriately at first visits. If you're concerned about your pain management approach or want to explore safer alternatives, Doctronic can help you understand your options quickly.

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