Background/Purpose: Chronic musculoskeletal pain (e.g. back and neck pain, pain due to arthritis, leg pain, arm pain) affects up to 24% of the general population. Various approaches, both pharmacologic and nonpharmacologic, have been developed to manage chronic pain. With respect to pharmacological treatments, the overuse of opioid medications has led to an epidemic, even though many other evidence-based treatments are available and effective. Current guidelines recommend pharmacologic and nonpharmacologic treatments should be optimized before initiating a trial of opioids. The goal of this study was to explore initial clinical management of chronic musculoskeletal pain. We sought 1) to explore what treatments are prescribed at the initial visit with the physician for chronic musculoskeletal pain: i.e. medications, physical therapy, counseling; and 2) to describe factors associated with these prescribed treatments or services: more specifically clinician-related factors and patient-related factors.

Methods: We analyzed data from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey-Out Patient Department (NAMCS) between 2007 and 2015. Visits with a new chronic musculoskeletal pain condition were identified using pre-determined diagnostic criteria. We documented the following treatment prescriptions: opioids, non-opioid pain medication, physical therapy, mental health counseling, stress management, injury prevention, exercise, diet, weight reduction and health education. We used logistic regression to explore associations between patient and provider factors and each of these prescription categories. Data were programmed using SUDAAN and descriptive statistics are presented. Logistic regression models to determine physician and patient-related factors associated with treatment prescription will be calculated.

Results: There were 19,341 initial visits over the 9-year period with a diagnosis of chronic musculoskeletal pain in the NAMCS database translating into 528,715,590 weighted initial visits. Mean age of patients at these initial visits was 49.4 years (95% confidence interval: 48.7-50.0) and 58.9% were female. The proportions of patients that were prescribed the following medications: NSAIDs, opioids, acetaminophen and muscle relaxants were 27.98, 19.15,16.8, and 10.19% respectively. The proportion of visits with referral to physical therapy was 9.73%, counseling for mental health 0.3%, stress management 0.92%, injury prevention 5.52%, exercise 10.60%, diet 6.47%, weight reduction 2.66%, and health education 14.03%. Ongoing analyses will elucidate patient and physician related factors associated with these various categories of treatment prescriptions.

Conclusion: There is a high frequency of visits for chronic musculoskeletal pain conditions. The frequency for opioid prescription was nearly double that of physical therapy. This result is troubling in view of the evidence and current guidelines that support non-opioid treatments for chronic musculoskeletal pain conditions.

« Back to 2018 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/how-are-patients-with-chronic-musculoskeletal-pain-conditions-being-managed-initially-in-the-u-s/