(114) Secular Trends in Utilization of Pharmacologic and Non-Pharmacologic Pain Management Strategies Among Patients with Hip or Knee Osteoarthritis

Publication Number: 788

Background: Osteoarthritis (OA) affects at least 14 million people in the US with the most common presentation being pain. Treatment of pain is an important component of OA management and typically involves analgesics; however, with the ongoing opioid epidemic in the US, it is unclear whether utilization of strategies for pain control has changed over time in this patient population.

Objectives: To describe the utilization of pharmacologic and non-pharmacologic pain management strategies over calendar time among OA patients.

Methods: Using administrative claims data (2005-2019) from Optum Clinformatics Data Mart, we selected patients aged 60 years or older who had continuous health plan enrollment and one International Classification of Disease (ICD) code for hip or knee OA in the twelve months preceding the date of the second ICD code for OA (i.e., index date). We further required patients to have continuous health plan enrollment in the twelve months after the index date. Utilization patterns of prescription opioids, non-steroidal anti-inflammatory drugs (NSAIDs), gabapentinoids, duloxetine, skeletal muscle relaxants, total knee replacement (TKR), and total hip replacement (THR) surgeries were assessed over calendar time using the twelve months after the index date for each patient. We also quantified the total morphine milligram equivalents (MMEs) available per patient in each calendar year.

Results: We identified a total of 335,705 patients with hip or knee OA during the study period. The mean age on the index date was 72 years (standard deviation: 7 years), and 59% were female. Prescription opioid use remained relatively constant from 28% in 2005 to 24% in 2012, then declined sharply over time to 9% in 2019; total opioid dosage per patient also decreased from 1,328 MMEs to 1,036 MMEs over the same period. Skeletal muscle relaxant (2-3%) and duloxetine (1-2%) use were constant over 15 years, NSAID use declined over time from 24% to 17%, and gabapentinoid use steadily increased from 3% in 2005 to 7% in 2019. TKR gradually declined from 14% in 2005 to 4% in 2019, while THR did not change significantly over time.

Conclusions: In this utilization study of hip and knee OA patients spanning 15 years, prescription opioid use declined without any commensurate uptake in alternative pharmacologic or non-pharmacologic strategies for pain management. Future studies may seek to evaluate whether chronic pain is sufficiently managed in these patients with current strategies or if the decline in opioid use may reflect prior inappropriate prescribing.