Trends in the Use of Opioids vs Nonpharmacologic Treatments in Adults With Pain, 2011-2019.

Importance: Chronic pain prevalence among US adults increased between 2010 and 2019. Yet little is known about trends in the use of prescription opioids and nonpharmacologic alternatives in treating pain. Objectives: To compare annual trends in the use of prescription opioids, nonpharmacologic alternatives, both treatments, and neither treatment; compare estimates for the annual use of acupuncture, chiropractic care, massage therapy, occupational therapy, and physical therapy; and estimate the association between calendar year and pain treatment based on the severity of pain interference. Design, Setting, and Participants: A serial cross-sectional analysis was conducted using the nationally representative Medical Expenditure Panel Survey to estimate the use of outpatient services by cancer-free adults with chronic or surgical pain between calendar years 2011 and 2019. Data analysis was performed from December 29, 2021, to August 5, 2022. Exposures: Calendar year (2011-2019) was the primary exposure. Main Outcomes and Measures: The association between calendar year and mutually exclusive pain treatments (opioid vs nonpharmacologic vs both vs neither treatment) was examined. A secondary outcome was the prevalence of nonpharmacologic treatments (acupuncture, chiropractic care, massage therapy, occupational therapy, and physical therapy). All analyses were stratified by pain type. Results: Among the unweighted 46 420 respondents, 9643 (20.4% weighted) received surgery and 36 777 (79.6% weighted) did not. Weighted percentages indicated that 41.7% of the respondents were aged 45 to 64 years and 55.0% were women. There were significant trends in the use of pain treatments after adjusting for demographic factors, socioeconomic status, health conditions, and pain severity. For example, exclusive use of nonpharmacologic treatments increased in 2019 for both cohorts (chronic pain: adjusted odds ratio [aOR], 2.72; 95% CI, 2.30-3.21; surgical pain: aOR, 1.53; 95% CI, 1.13-2.08) compared with 2011. The use of neither treatment decreased in 2019 for both cohorts (chronic pain: aOR, 0.43; 95% CI, 0.37-0.49; surgical pain: aOR, 0.59; 95% CI, 0.46-0.75) compared with 2011. Among nonpharmacologic treatments, chiropractors and physical therapists were the most common licensed healthcare professionals. Conclusions and Relevance: Among cancer-free adults with pain, the annual prevalence of nonpharmacologic pain treatments increased and the prevalent use of neither opioids nor nonpharmacologic therapy decreased for both chronic and surgical pain cohorts. These findings suggest that, although access to outpatient nonpharmacologic treatments is increasing, more severe pain interference may inhibit this access.

Association between cannabis laws and opioid prescriptions among privately insured adults in the US.

We examine the association between opioid prescription patterns in privately insured adults and changes in state cannabis laws among five age groups (18-25, 26-35 36-45, 46-55 and 56-64 years). Using the 2016 Clinformatics Data Mart, a nationwide commercial health insurance database, we performed a cross-sectional analysis of two types of opioid prescribing (>30-day and >90-day prescriptions) among all adults aged 18-64 based on the stringency of cannabis laws. We found a significant interaction between age and cannabis law on opioid prescriptions. Age-stratified multilevel multivariable analyses showed lower opioid prescription rates in the four younger age groups only in states with medical cannabis laws, when considering both >30 day and >90 day opioid use [>30 day adjusted odds ratio (aOR) = 0.56, in 18-25, aOR = 0.67 in 26-35, aOR = 0.67 in 36-45, and aOR = 0.76 in 46-54 years; >90 day aOR = 0.56, in 18-25, aOR = 0.68 in 26-35, aOR = 0.69 in 36-45, and aOR = 0.77 in 46-54 years, P < 0.0001 for all]. This association was not significant in the oldest age group of 55-64 years. There was no significant association between opioid prescriptions and other categories of cannabis laws (recreational use and decriminalization) in any of the age groups studied.

Chamomile Consumption and Mortality: A Prospective Study of Mexican Origin Older Adults.

PURPOSE: Approximately 20% of adults use some kind of herbal; however, little data exists from population-based study or clinical trials to support effectiveness of most herbal products. Chamomile is a commonly used herb among older adults of Mexican origin. We examined the effects of herbal chamomile consumption on mortality among older adults of Mexican origin. METHODS AND DESIGN: A sample from the Hispanic Established Populations for Epidemiologic Study of the Elderly, a population-based study of noninstitutionalized Mexican Americans aged 65 and older from five Southwestern states (Texas, California, New Mexico, Colorado, and Arizona). We included all men and women from 2000 to 2007 (n = 1,677). RESULTS: Chamomile was used by 14% of the sample. Cox proportional hazards regression analyses showed that chamomile was associated with a decreased risk of mortality in the total sample (hazard ratio [HR] 0.71, 95% confidence interval [CI] 0.55-0.92) and for women (HR 0.67, 95% CI 0.49-0.92) but not for men. In models adjusted for sociodemographic variables, health behaviors, and chronic conditions, chamomile remained significantly associated with reduced mortality in women (HR 0.72, 95% CI 0.53-0.98). IMPLICATIONS: The use of chamomile shows protective effects against mortality in this sample of older adults of Mexican origin for women. Further research is warranted in other populations to determine if these effects are consistent.

Church attendance mediates the association between depressive symptoms and cognitive functioning among older Mexican Americans.

BACKGROUND: The objective of this study was to examine how the effect of depressive symptoms on cognitive function is modified by church attendance. METHODS: We used a sample of 2759 older Mexican Americans. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) at baseline, 2, 5, 7, and 11 years of follow-up. Church attendance was dichotomized as frequent attendance (e.g., going to church at least once a month) versus infrequent attendance (e.g., never or several times a year). Depressive symptoms were assessed by the Center for Epidemiologic Studies Depression Scale (CES-D; score >or=16 vs <16). General linear mixed models with time-dependent covariates were used to explore cognitive change at follow-up. RESULTS: In unadjusted models, infrequent church attendees had a greater decline in MMSE scores (drop of 0.151 points more each year, standard error [SE] = 0.02, p <.001) compared to frequent church attendees; participants having CES-D scores >or=16 also had greater declines in MMSE scores (drop of 0.132 points more each year, SE = 0.03, p <.001) compared to participants with CES-D score <16 at follow-up. In fully adjusted models, a significant Church attendance x CES-D x Time interaction (p =.001) indicated that, among participants with CES-D scores >or=16, infrequent church attendees had greater decline in MMSE scores (drop of 0.236 points more each year, SE = 0.05, p <.001) compared to frequent church attendees at follow-up. CONCLUSION: Church attendance appears to be beneficial for maintaining cognitive function of older persons. Church attendance moderates the impact of clinically relevant depressive symptoms on subsequent cognitive function.

Ethnic differences in herb and vitamin/mineral use in the elderly.

BACKGROUND: Little information exists on herb and vitamin-mineral supplement use in very old people and whether use varies by ethnicity. OBJECTIVE: To examine the prevalence and predictors of herb and vitamin-mineral supplement use in a tri-ethnic sample of adults aged > or = 77 years. METHODS: In-home interviews in 1997-1998 assessed medications use and sociodemographic and health factors in community-dwelling elderly non-Hispanic white (n = 125), black (n = 112), and Hispanic (n = 128) adults. RESULTS: Of the 365 subjects (71.5% > or = 80 y old, 52.6% female), 172 reported using at least one of the preparations (vitamin-mineral supplements 132, herbs alone 21, both herbs and vitamin-mineral supplements 19). Herbal use varied by ethnicity: 12.8% in non-Hispanic whites, 16.1% in blacks, and 4.7% in Hispanics. The most commonly used herbs were garlic, Ginkgo biloba, saw palmetto, and vinegar. Use of vitamin-mineral supplements, alone or combined with herbs, also varied by ethnicity: 54.4% in non-Hispanic whites, 31.3% in blacks, and 37.5% in Hispanics. In the fully adjusted multivariate model with white ethnicity as reference, the odds ratio of vitamin-mineral supplements use for blacks was 0.37 (95% CI 0.21 to 0.65) and for Hispanics was 0.56 (95% CI 0.30 to 1.03). In bivariate analyses, female gender, black ethnicity, being born in the US, and having coronary artery disease were significantly associated with herbal use (p < 0.05); however, in the fully adjusted multivariate model, only the female gender remained significantly associated with herbal use (OR 2.14; 95% CI 1.00 to 4.59). CONCLUSIONS: Use of herbs or vitamin-mineral supplements is common in very old people and varies by ethnicity.