Study examines risk factors for chronic opioid use by vets with MS

People with multiple sclerosis and a history of chronic opioid use are nearly 200 times more likely to use prescription opioids persistently, according to a study involving nearly 15,000 U.S. military veterans living with the neurodegenerative condition.

A history of pain, paralysis, post-traumatic stress disorder, or living in a rural area also were factors that increased the risk of chronic prescription opioid use, the study found.

The prescription of opioids steadily declined during the three-year study. But the findings still showed that more than half of all opioid use was chronic, suggesting that more education and plans for discontinuing opioids should be introduced to avoid the complications associated with long-term use of these medications.

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April 28, 2023 Columns by Ed Tobias

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The study, “Risk factors for chronic prescription opioid use in Multiple Sclerosis,” was published in the journal Archives of Physical Medicine and Rehabilitation.

Chronic pain, defined as persistent or bothersome pain lasting for three months or longer, is a common symptom of MS, estimated to affect about 75% of patients.

It arises from a complex interplay of neural (e.g., central nervous system, somatosensory nervous system) and nonneural (e.g., musculoskeletal, psychosocial) factors, and can affect different body parts.

While opioid painkillers are prescribed commonly in the U.S. to ease chronic pain, prolonged use of opioids is linked with serious adverse outcomes. These include opioid use disorder, addiction, fractures, unintentional overdosing, transition to nonprescribed use, and suicide.

Moreover, their long-term effectiveness is unclear, with evidence suggesting that only a small fraction of patients experience pain relief.

Understanding how opioid painkillers are being used by patients with MS is essential to identify those at higher risk for chronic opioid use and related adverse outcomes.

Analysis of MS patient data

Within this in mind, a team led by researchers at the University of Washington, in Seattle, conducted an analysis of data from U.S. veterans diagnosed with MS before 2017 who received treatment in the Veterans Health Administration (VHA) from 2015 to 2017. These patients were selected from the Veterans Affairs MS National Data Repository.

In total, 14,974 veterans with MS (mean age 58 years) were included in the analysis. Most were non-Hispanic (92%), white (73.5%), married (54.5%), and lived in urban areas (66.7%). Also, more than half (62.2%) had been diagnosed with a pain condition, and 39.3% had depression.

The overall opioid use decreased from 27.3% in 2015 to 22.9% in 2017. During the three years, short-term use — opioid use for less than 90 days — was reduced from 12.8% to 10.7%. Chronic prescription opioid use, defined as lasting 90 days or more, dropped from 14.6% to 12.2%. Still, more than 50% of all annual opioid use was deemed chronic.

Statistical analysis showed that chronic opioid use in the prior year was the strongest risk factor for chronic opioid use. Participants with chronic opioid use in 2016 were 187.1 times more likely to to have chronic prescription opioid use in the following year, compared with people without prior chronic use.

Patients living in a rural area or with a history of other conditions also were more likely to have chronic use — by 1.3 to 1.8 times. These conditions included history of a pain condition, paraplegia (paralysis of the lower half of the body) or hemiplegia (paralysis affecting one body side), and post-traumatic stress disorder.

In contrast, a history of dementia and psychotic disorder were associated with a 60% lower likelihood of chronic use.

“Providers may be more reluctant to prescribe opioid medications that can further impact the mental status of patients with these conditions, and may adhere more closely to recommended prescribing guidelines,” the researchers wrote.

Education, awareness needed

Overall, these findings show that “chronic prescription opioid use remains common among a substantial minority of Veterans with MS,” the researchers wrote, adding that particular caution is needed when considering opioid prescriptions in patients carrying risk factors for chronic use.

“The prevalence and persistence of chronic use over time suggests education about long term opioid use, review of non-pharmacologic treatment options, and discussion of a plan for opioid discontinuation should be reviewed with patients prior to initial prescription,” they concluded.