Complexity of Pain Management Among Patients with Nociceptive or Neuropathic Neck, Back, or Osteoarthritis Diagnoses

BACKGROUND: Approaches to pain management are diverse, requiring prescribers to evaluate an array of clinical issues and potential solutions. In edition to the difficult task of selecting a treatment option, pain treatment may be further complicated by multiple prescribers, multiple medications, and multiple mechanisms of pain origination. OBJECTIVE To describe patient demographics (e.g., age, gerder); comorbidties; office visits (e.g., physician, chiropractor, physical therapy, psychiatry, allergist); number of different prescribers overall prescription use; pain medicaticns as classified by the World Health Organization's (WHO pain ladder; adjuvant medications; nonpharmacologic procedures; and potential drug interactions in a broad sane of patients with nociceptive or neuropathic neck or back diagnoses, or osteoarthritis diagnoses, in a commercial population. METHODS This claims-data analysis used a cross-sectional cohort comparison with a fixed 2-year observation period from September 1, 2006, to August 31, 2008, for patients in the PharMetrics national managed care database. The assigned cohorts were neuropathic-related neck/back diagnoses (NEURO); neuropathic and nociceptive neck/back diagnoses (NEURO/ NOD); nociceptive neck/back diagnoses without a neuropathic-related diagnosis (NCO); and only osteoarthritis (CA) diagnoses. All analyses were conducted by cohort. The analysis included the following patient-descriptive variables: patient demographics, camorbidities, office visits, most frequent medical providers and number of different prescribers, all medications, pain medications as classified by the WHO pain ladder, adjuvent medications, adjuvant procedures and potential drug interactions. The goal for selecting these variables was to describe a range of data that night provide insight into the complexity of pain management decisions faced by clinicians. RESULTS: The study included 85,014 patients, classified as NEURO (n= 2,375), NEURO/ NCO (n=37019), NOD (n=39,496), and CA (n= 6,124). The most frequently occurring comorbicities (observed in > 40% of patients) included cardiovascular and neuropathic pain conditions. Considering all types of medication claim observed among all cohorts, the overall mean prescription claim count for the 2-year observation period was 579 claims (standard deviation 56.2). Weak opioids (WHO pain relief ladder rung 2) accounted for the majority of pain medication claims across all cohorts. Across cohorts, 25.7% of patients had 10 or more days of overlapping drug availability (for inducers or inhibitors of the cytochrome P450 system concomitantly), a measure of potential for drug interactions. CONCLUSIONS Choosing the appropriate pain treatment involves assessing currently used medallions for existing illnesses and deciding on the appropriate types of pain medications. However, potentially serious drug-drug interactions are a consequence of multiple drug use, and such a potential requires thoughtful consideration by those involved in patient care. Copyright (C) 2014, Academy of Managed care Pharmacy. All rights reserved