Background/Purpose: Chronic musculoskeletal (MSK) pain has been associated with chronic illnesses, including mental disorders, and with high rates of pain medication use, often in referral centers, European populations, or studies focused on single drug classes. We aimed to characterize broad patterns of comorbidities and treatments associated with chronic MSK pain in a nationally representative sample of US youth.

Methods: We used the National Ambulatory Medical Care Survey (2002-2015) and outpatient National Hospital Ambulatory Medical Care Survey (2002-2011), which contain national cross-sectional data on demographics, reasons for visit (RFV), diagnoses, and drugs ordered in visits to US office-based physicians. The study included all visits for youth age 8-24, excluding those for MSK pain of unknown duration or with diagnoses of malignancy or sickle cell disease. We identified visits for chronic (≥3mo) or acute (< 3mo) MSK pain based on the main RFV. We compared comorbidities and drugs ordered in visits for chronic MSK pain with (1) visits for any reason besides MSK pain (primary) and (2) visits for acute MSK pain (secondary), using chi-square tests and logistic regression, adjusting for age, sex, race, ethnicity, insurance, and setting of care.

Results: Chronic and acute MSK pain accounted for 1.3% and 4.1% of all visits, respectively. Chronic diseases besides mental disorders were more common among visits for chronic MSK pain (32.0%) in comparison to both visits for acute MSK pain (17.9%) and visits for other reasons (18.8%) (Table). Mental disorders and psychotropic drugs were more common in visits for chronic MSK pain than for acute MSK pain but not compared to visits for other reasons (Table). Nonsteroidal anti-inflammatories were more commonly ordered in visits for chronic MSK pain (23.9%) than in non-pain visits (4.7%) but not compared to acute MSK pain visits (31.3%) (Table). Opioids were also more common in visits for chronic MSK pain (13.5%) than non-pain visits (2.1%) and, to a lesser extent, acute MSK pain visits (8.4%) (Table). Orders for gabapentinoids and complementary and alternative medicine (CAM) were markedly higher in visits for chronic MSK pain (Table). Orders for opioids, muscle relaxants, and psychotropic drugs increased over time in visits for chronic MSK pain; similar trends were seen in other groups for psychotropic drugs but not pain medicines (Figure).

Conclusion: Compared to youth without pain,youthwith chronicMSK weremore likely to have chronic non-psychiatric medical conditions but not mental disordersin a large ambulatory US population. Orders for gabapentanoids (unapproved for children with chronic MSK pain) and CAM were particularly common for those with chronic MSK pain, and orders for opioids and muscle relaxants rose over time in this group. Further research must clarify the effectiveness and safety of treatments commonly used to treat youth with chronic MSK pain.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/comorbidities-and-treatments-in-united-states-youth-with-chronic-musculoskeletal-pain/