Background

Heightened risks of dependence, addiction, anxiolytic effects, or prescription overdose death due to long-term use of pain medication have increased awareness about extended pain medication use in chronic pain populations. The goal of this study was to evaluate the incidence and prevalence of pain medication prescriptions from 2012 to 2022 in common pathologies with a potential for chronic pain.

Methods

A retrospective cohort study was conducted using electronic health records from TriNetX (Cambridge, Massachusetts) Global Collaborative Network. For 10 distinct cohorts (total n = 9,357,584 patients), pain medication prescriptions were extracted for five classes, namely nonsteroidal anti-inflammatory drug (NSAIDs) and acetaminophen, opioids, gabapentinoids, neuropathic mood agents, and muscle relaxants. Annual incidence and prevalence of each class of medication were evaluated for the past 11 yr.

Results

From 2012 to 2022, there was a significant increase in prescriptions of NSAIDs, except for patients with fibromyalgia, and persistent spinal pain syndrome (PSPS) type 2. Interestingly, over time, prescriptions of opioids in patients with complex regional pain syndrome, endometriosis, osteoarthritis, and PSPS type 2 increased, as did prescriptions of muscle relaxants for all cohorts except those with fibromyalgia. Incidence of prescriptions of neuropathic mood agents is high for patients with complex regional pain syndrome (both types) and PSPS type 2. Only for benzodiazepines did there seem to be a decline over the years, with a significantly decreased time trend in patients with complex regional pain syndrome type 1, fibromyalgia, and PSPS type 2.

Conclusions

During the last 11 yr, an increase in incidence of NSAIDs and acetaminophen, opioids, neuropathic agents, and muscle relaxants was observed. Only prescriptions of benzodiazepines significantly decreased over time in specific cohorts. Overall, patients with PSPS type 2 and complex regional pain syndrome (both types) consume a broad variety of pain medication classes.

Editor’s Perspective
What We Already Know about This Topic
  • The “Guideline for Prescribing Opioids for Chronic Pain” released by the Centers for Disease Control and Prevention in 2016 stipulating that nonpharmacologic and nonopioid pharmacologic therapies are preferred for chronic pain management led to a decrease in opioid prescribing
  • There are risks associated with not only long-term opioid use but also the use of other pain medication
What This Article Tells Us That Is New
  • The annual incidence and prevalence of pain medication prescriptions from 2012 to 2022 were evaluated in 10 distinct cohorts of common pathologies and pathologic conditions with a potential for chronic pain using electronic health records of 9,357,584 patients
  • The incidence of nonsteroidal anti-inflammatory drugs and acetaminophen, opioids, neuropathic mood agents, and muscle relaxants prescriptions increased over time; only the incidence of benzodiazepines prescriptions decreased
  • In 2022, medication prevalence ranged between 66.1 and 87.3% for nonsteroidal anti-inflammatory drugs, 51.4 and 87.9% for opioids, 26.3 and 50.6% for benzodiazepines, 49.1 and 79.5% for neuropathic mood agents, and 30.0 and 66.5% for muscle relaxants