A Large Retrospective Observational Study of Nonpharmacologic Treatment Use Among German Patients Receiving Long-Term Opioid Therapy for Chronic Noncancer Pain.

introductionEvidence-based practice guidelines recommend combining the long-term use of opioids for chronic noncancer pain (CNCP) with suitable nonpharmacologic treatments. Whether long-term opioid therapy (LTOT) in Germany aligns with these recommendations is unknown so far. Therefore, our objective was to determine the use of nonpharmacologic treatments among patients receiving LTOT for CNCP.

methodsThe retrospective observational analysis was based on administrative claims data of the German statutory health insurance fund DAK-Gesundheit. Patients with LTOT and no cancer diagnosis were selected between January 2018 and June 2019. The utilization of nonpharmacologic treatments, including physical therapy, psychotherapy, lifestyle modification, and other inpatient and outpatient treatments, was examined over a two-year period. Subgroup analyses were conducted by age, preindex opioid prescriptions (≥ 1 year vs < 1 year), and the presence of ICD-10 diagnoses, including osteoarthritis, chronic back pain, inflammatory rheumatic diseases (excluding rheumatoid arthritis), neuropathy/polyneuropathy, radiculopathy, and chronic pain disease. Additionally, regression analyses were performed to examine the association between diagnostic groups and the utilization of treatments.

resultsA total of 113,476 patients met the inclusion criteria, of whom 25,945 (23%) did not utilize any of the defined nonpharmacologic treatments during the two-year observation period. The most frequently utilized treatment was physical therapy (62%). Psychotherapy was used by 7% of patients, outpatient special pain therapy by 16%, whereas lifestyle modification (relaxation exercises and nutrition therapy) was used by fewer than 30 patients. Patients with ≥ 1 year of opioid prescriptions prior to inclusion and elderly patients utilized most treatments less frequently. Over the 2-year period, treatment provision remained largely constant, except for a steady decline in physical therapy for patients who had initiated opioid therapy more recently. Except for chronic pain disease, certain diagnoses were only weakly associated with treatment utilization.

conclusionsContrary to guideline recommendations, a notable proportion of LTOT patients may not receive pain management combining opioid therapy with nonpharmacologic treatments, particularly elderly patients and those with longer treatment duration. Future research should examine reasons for the low use of nonpharmacologic treatments.

trial registrationGerman Clinical Trials Register: DRKS00024854.