疼痛与阿片类药物治疗了,少与物理Therapy, During COVID-19 Pandemic

Opioid prescriptions for chronic pain surged during theCOVID-19 pandemicas utilization of physical therapy — a low-risk alternative treatment forpain management— declined, according to astudy published in December 2021 inJAMA Network Open.

To examine shifts in treatment of chronic pain, researchers looked at private health insurance claims data for more than 24 million Americans. They focused on three distinct phases of the pandemic in 2020: the prepandemic period, before a national emergency was declared on March 13; the early pandemic period, with widespread stay-at-home orders, that ran through July 4; and a late pandemic period, after life opened up again in many places, that extended through September 30. They compared the prevalence of pain diagnoses and treatments in each of these three pandemic periods of 2020 with the same timespans in 2019.

During the early pandemic period, when life ground to a halt in so many ways, the proportion of patients with chronic pain diagnoses, such as back, neck, or joint pain, declined about 16 percent compared with the same timeframe in 2019. Over the early pandemic period, the proportion of patients with chronic pain who gotopioids上涨3.5%和比例d physical therapy or other nonmedication treatments fell 6 percent.

Even more troubling, people on opioids during the early pandemic period stayed on these medications longer and took larger doses than they did during the same weeks of 2019.

“Prior to the COVID-19 pandemic, opioid prescriptions were declining and physical therapy usage was increasing, says lead study author通过ungkyu Lee, PhD, an assistant professor of sociology at Indiana University in Bloomington.

“We show that the pandemic may have reversed these patterns, particularly during the early stages of the outbreak,” Dr. Lee says.

Surging Opioid Overdose Deaths

While the study didn’t focus on opioid misuse, it’s possible that increased reliance on these drugs by pain patients may have indirectly contributed to the record increases in opioid overdose deaths during the pandemic, Lee says.

Late last year, theCenters for Disease Control and Prevention (CDC) reportedthat there were more than 83,000 drug overdose deaths during the 12 months ending in May 2020, a record high at the time that was fueled in large part by a 38.4 percent surge in fatalities from synthetic opioids and illegally manufacturedfentanyl.

This trend shows no sign of abating. In November 2021, the CDC reported that more than100,000 people diedof drug overdoses in the 12 months ending in April 2021, shattering a previous record for the most deaths ever recorded in a one-year period. The majority of these deaths — 76,056 — were from opioid overdoses.

In theory, people who managed pain with opioids earlier in the pandemic might be able to start or resume physical therapy as an alternative now, Lee says. But many people who lost jobs or income during the pandemic may still struggle to afford or access care.

“Many patients will continue to be unable to get nonpharmacologic therapy due to issues such as cost, underinsurance, lack of transportation, childcare, or inability to take time off work,” Lee says. “These barriers disproportionately affect people in rural areas, Black and Latinx patients, gender and sex minorities, and those in disadvantaged socioeconomic groups and thus may contribute to broader disparities in opioid use disorders and overdose.”

There’s A Growing Trend That’s Moving Away From PT To Treat Pain

One limitation of the study is that it focused only on individuals with private health insurance, and results might not be applicable to people who are uninsured or covered by government health programs like Medicaid. Another drawback is that opioid usage data was based on prescriptions people filled, which might not necessarily reflect how many pills they actually took.

The study also wasn’t designed to determine why clinicians may have prescribed opioids or physical therapy for individual patients, making it hard to know how much of this was influenced by changes in the magnitude of pain or disability patients experienced or by other factors, saysHarlan Krumholz, MD, a professor at the Yale University School of Medicine in New Haven, Connecticut, who has researched trends in opioid misuse.

“The pressures on the system in 2021 have not lessened compared with 2020,” Dr. Krumholz says. “And if this is a result of clinician propensity to prescribe opioids, then we need more work to determine why that happened and the long-term impact on populations.”

Results of the current study mirror earlier documenting a shift away from physical therapy and other alternative treatments for pain management during the pandemic. Onestudy, published in February 2021 in theJournal of the American Board of Family Medicine, for example, followed 528 patients with chronicback painin Texas, and they were more than half as likely to use physical therapy or massage therapy to manage pain during the pandemic than they were before.

As the pandemic progressed — and stay-at-home orders lifted along with some limits on in-person medical care — the current study did find a small dip in opioid prescribing and a slight uptick in use of physical therapy for chronic pain.

“This suggests that opioid prescriptions were used as a stopgap measure during a time when nonpharmacologic therapies were not available, saysDanielle Haley, MPH, PhD, an assistant professor of community health services at the Boston University School of Public Health in Massachusetts, who wasn’t involved in the study.

Completely reversing the pandemic trend towards more opioid use and less reliance on physical therapy or other alternatives to manage chronic pain will be still be hard, Krumholz says.

“Our history with opioids tells us that it is challenging to reverse course,” Krumholz says. “Patients and their clinicians found it far too easy to use opioids and far too hard to stop.”