TY - JOUR
T1 - A Longitudinal Study of the Association of Opioid Use with Change in Pain Interference and Functional Limitations in a Nationally Representative Cohort of Adults with Osteoarthritis in the United States
AU - Shah, Drishti
AU - Zhao, Xiaohui
AU - Wei, Wenhui
AU - Gandhi, Kavita
AU - Dwibedi, Nilanjana
AU - Webster, Lynn
AU - Sambamoorthi, Usha
N1 - Funding Information:
For this study, the journal’s Rapid Service and Open Access Fees were funded by Regeneron Pharmaceuticals, Inc. and Teva Pharmaceutical Industries, Ltd.
Funding Information:
For this study, the journal’s Rapid Service and Open Access Fees were funded by Regeneron Pharmaceuticals, Inc. and Teva Pharmaceutical Industries, Ltd. The authors acknowledge E. Jay Bienen, PhD, for medical writing support and StemScientific (an Ashfield Company, part of UDG Healthcare plc) for editorial support during development of this manuscript. Support for this assistance was funded by Regeneron Pharmaceuticals, Inc. and Teva Pharmaceutical Industries, Ltd. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. Some data included in this manuscript were presented at the 2018 PAINWeek congress. Drishti Shah, Xiaohui Zhao, Nilanjana Dwibedi, and Usha Sambamoorthi are paid consultants for Regeneron Pharmaceuticals, Inc. and Teva Pharmaceuticals Industries. Wenhui Wei is an employee and stockholder of Regeneron Pharmaceuticals, Inc. Lynn Webster has served on advisory boards for Charleston Laboratories, Depomed, and Inspirion, and has served as a consultant to Alcobra, Bonti, Charleston Laboratories, Eaglet, Depomed, Indivior, Insys, Kempharm, Pernix, Pain Therapeutics, Shionogi, Daiichi Sankyo, Trevena, Trevi, and Teva Pharmaceutical Industries. Kavita Gandhi was an employee of Teva Pharmaceutical Industries at the time of this study, and is currently an employee of Pfizer Inc. The current study used secondary data from the Medical Expenditures Panel Survey, a publicly available database. As such, all ethics approvals and consent to participate were waived by the institutional review board at West Virginia University. The data used to support the findings of this study are from MEPS Household Component public use data files, which can be downloaded from https://meps.ahrq.gov/mepsweb/data_stats/download_data_files.jsp.
Publisher Copyright:
© 2019, The Author(s).
PY - 2020/2/1
Y1 - 2020/2/1
N2 - Introduction: Real-world data are sparse on longitudinal associations of opioid use with pain interference with activities (PIA) and daily function with osteoarthritis (OA) in the USA. Methods: Data from the 2010–2015 Medical Expenditure Panel Surveys were analyzed for community-dwelling adults with OA. Opioid use patterns were defined as persistent, intermittent, and no use. Evaluated outcomes were a change in PIA and functional limitations (activities of daily living [ADL], instrumental ADL [IADL], social and work activities, and cognitive function). Multivariable regression analyses explored the association of persistent/intermittent versus no opioid use with PIA and functional limitations. Results were weighted for the US population. Results: Among 4172 patients (66.2% female, 80.8% white, mean age 61.7 years), 62.1% reported no PIA change at follow-up, 17.9% worsened, and 20.0% improved. Although 51.0–93.1% of patients reported no functional limitations, 3.8–13.1% worsened (1.1–11.3% improved). Relative to no opioid use, persistent users had higher odds of severe/extreme PIA (adjusted odds ratio [AOR], 2.91; 95% confidence interval [CI], 1.95–4.32; P < 0.001) and moderate PIA (AOR, 2.04; 95% CI, 1.31–3.20; P < 0.01) at follow-up. For patients with baseline functional limitations, persistent opioid users were more likely to report physical and work limitations at follow-up (both P < 0.05). For patients without baseline functional limitations, persistent opioid users had higher odds than those without use of reporting IADL, physical, social, and cognitive limitations at follow-up (all P < 0.05); intermittent users were more likely to report physical and social limitations (both P < 0.05). Conclusions: Persistent opioid use for pain in patients with OA appeared to be associated with poorer PIA and functional outcomes, regardless of baseline functional status. These findings highlight the importance of patient-reported outcomes for opioid benefit–risk assessment and suggest the need for alternative analgesic approaches.
AB - Introduction: Real-world data are sparse on longitudinal associations of opioid use with pain interference with activities (PIA) and daily function with osteoarthritis (OA) in the USA. Methods: Data from the 2010–2015 Medical Expenditure Panel Surveys were analyzed for community-dwelling adults with OA. Opioid use patterns were defined as persistent, intermittent, and no use. Evaluated outcomes were a change in PIA and functional limitations (activities of daily living [ADL], instrumental ADL [IADL], social and work activities, and cognitive function). Multivariable regression analyses explored the association of persistent/intermittent versus no opioid use with PIA and functional limitations. Results were weighted for the US population. Results: Among 4172 patients (66.2% female, 80.8% white, mean age 61.7 years), 62.1% reported no PIA change at follow-up, 17.9% worsened, and 20.0% improved. Although 51.0–93.1% of patients reported no functional limitations, 3.8–13.1% worsened (1.1–11.3% improved). Relative to no opioid use, persistent users had higher odds of severe/extreme PIA (adjusted odds ratio [AOR], 2.91; 95% confidence interval [CI], 1.95–4.32; P < 0.001) and moderate PIA (AOR, 2.04; 95% CI, 1.31–3.20; P < 0.01) at follow-up. For patients with baseline functional limitations, persistent opioid users were more likely to report physical and work limitations at follow-up (both P < 0.05). For patients without baseline functional limitations, persistent opioid users had higher odds than those without use of reporting IADL, physical, social, and cognitive limitations at follow-up (all P < 0.05); intermittent users were more likely to report physical and social limitations (both P < 0.05). Conclusions: Persistent opioid use for pain in patients with OA appeared to be associated with poorer PIA and functional outcomes, regardless of baseline functional status. These findings highlight the importance of patient-reported outcomes for opioid benefit–risk assessment and suggest the need for alternative analgesic approaches.
KW - Functional limitations
KW - Medical expenditure panel survey
KW - Opioids
KW - Osteoarthritis
KW - Pain interference with activities
UR - http://www.scopus.com/inward/record.url?scp=85077158240&partnerID=8YFLogxK
U2 - 10.1007/s12325-019-01200-4
DO - 10.1007/s12325-019-01200-4
M3 - Article
C2 - 31875300
AN - SCOPUS:85077158240
SN - 0741-238X
VL - 37
SP - 819
EP - 832
JO - Advances in Therapy
JF - Advances in Therapy
IS - 2
ER -