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Spine (Phila Pa 1976). 2019 Mar 4. doi: 10.1097/BRS.0000000000003033. [Epub ahead of print]

Healthcare Costs and Opioid Use Associated with High-Impact Chronic Spinal Pain in the United States.

Author information

1
RAND Health, RAND Corporation, Santa Monica, CA.
2
Center for the Evaluation of Value and Risk in Health, Institute of Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA.
3
RAND Corporation, Pittsburgh, PA.

Abstract

STUDY DESIGN:

Descriptive analysis of secondary data.

OBJECTIVE:

Estimate healthcare costs and opioid use for those with high-impact chronic spinal (back and neck) pain.

SUMMARY OF BACKGROUND DATA:

The US National Pain Strategy introduced a focus on high-impact chronic pain-i.e., chronic pain associated with work, social and self-care restrictions. Chronic neck and low-back pain are common, costly, and associated with long-term opioid use. Although chronic pain is not homogenous, most estimates of its costs are averages that ignore severity (impact).

METHODS:

We used 2003-2015 Medical Expenditures Panel Survey (MEPS) data to identify individuals with chronic spinal pain, their healthcare expenditures, and use of opioids. We developed prediction models to identify those with high- versus moderate- and low-impact chronic spinal pain based on the variables available in MEPS.

RESULTS:

We found that overall and spine-related healthcare costs, and the use and dosage of opioids increased significantly with chronic pain impact levels. Overall and spine-related annual per person healthcare costs for those with high-impact chronic pain ($14,661 SE: $814; and $5,979 SE: $471, respectively) were more than double that of those with low-impact, but still clinically significant, chronic pain ($6,371 SE: $557; and $2,300 SE: $328). Those with high-impact chronic spinal pain also use spine-related opioids at a rate almost four times that of those with low-impact pain (48.4% versus 12.4%), and on average use over five times the morphine equivalent daily dose (MEDD) in mg (15.3 SE: 1.4 versus 2.7 SE: 0.6). Opioid use and dosing increased significantly across years, but the increase in inflation-adjusted healthcare costs was not statistically significant.

CONCLUSIONS:

Although most studies of chronic spinal pain do not differentiate participants by the impact of their chronic pain, these estimates highlight the importance of identifying chronic pain levels and focusing on those with high-impact chronic pain.

LEVEL OF EVIDENCE:

3.

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