Opioids Prescribed for Diabetic Neuropathy Pain, Against Adv
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Prescriptions for opioids as a first-line treatment for painful diabetic peripheral neuropathy (DPN) outnumbered those for other medications between 2014 and 2018, despite the fact that the former is not recommended, new research data indicates.

“The data also reveal that while opioid prescribing dropped over the study period, there wasn't a comparable rise in prescriptions of recommended pain medications, suggesting that recent efforts to minimize opioid prescribing may have resulted in less overall treatment of significant pain,” researchers at the Mayo Clinic in Rochester, Minnesota said.

The study involved 3495 adults with newly-diagnosed DPN from all three Mayo Clinic locations in Rochester, Minnesota; Phoenix, Arizona; and Jacksonville, Florida during the period 2014-2018. Of those, 40.2% (1406) were prescribed a new pain medication after diagnosis. However, that proportion dropped from 45.6% in 2014 to 35.2% in 2018.

The odds of initiating any treatment were significantly greater among patients with depression, arthritis, and back pain, but decreased over time among all patients.

Among those receiving drug treatment, opioids were prescribed to 43.8%, whereas guideline-recommended medications (gabapentin, pregabalin, and serotonin-norepinephrine reuptake inhibitors including duloxetine) were prescribed to 42.9%.

Another 20.6% received medications deemed "acceptable" for treating neuropathic pain, including topical analgesics, tricyclic antidepressants, and other anticonvulsants.

Males were significantly more likely than females to receive opioids, while individuals diagnosed with comorbid fibromyalgia were less likely. Those with comorbid arthritis were less likely to receive recommended DPN medications.

Use of opioids was 29% less likely in 2018 compared with 2014, although this difference did not achieve significance. Similarly, use of recommended medications was 25% more likely in 2018 compared with 2014, also not a significant difference.

“Our analyses are limited by the inability to examine the clinical context of pain management, including pain severity and other potential indications for opioid therapy, or contraindications to guideline-recommended treatments,” researchers stated. “Our sample size may be underpowered to ascertain factors associated with the choice of specific treatment regimens.”

“Further research is needed to examine DPN management trends nationally, identify factors associated with opioid use and barriers to evidence-based alternatives, and develop interventions to improve DPN management in clinical practice,” they mentioned.