Health care utilization and opioid prescriptions for chronic pain in low-income settings
Chronic pain is a serious health problem with high rates of health care utilization (HCU) and opioid prescriptions (OP). Many patients become stymied in a perpetual cycle of unsuccessful attempts to find relief from suffering through frequent health care visits and opioid prescriptions. Especially within low-income populations, the burdens of health care services and pain medications are especially unpleasant due to significant financial costs, barriers to transportation, and high levels of stress. Research is currently limited in examining the various factors associated with HCU and OP within low-income settings. The Learning About My Pain (LAMP) trial is a randomized comparative effectiveness study of group-based psychosocial interventions (PCORI Contract #941, Beverly Thorn, PI; clinicaltrials.gov identifier NCT01967342) for patients receiving care for chronic pain at low-income clinics in rural and suburban Alabama. As part of the LAMP study, medical records one-year prior to study onset were retrospectively collected for data analysis on HCU and OP. Sociodemographic traits (age, gender, race, poverty status, primary literacy, and education level), pain related variables (pain severity, pain interference, disability, number of pain sites, number of pain types, and opioid prescriptions), and psychological variables (depressive symptoms and pain catastrophizing) were entered into a hierarchical multiple regression model to predict health care utilization. Results suggested that being Black/African-American, having received an opioid prescription in the year prior to treatment onset, and higher depressive symptoms were associated with increased health care utilization for chronic pain conditions. Study findings suggest the need for a biopsychosocial approach to chronic pain management.