Risk Factors for Chronic Opioid Use Includes a History of Chronic Opioid Use in Veterans With MS

Chronic pain, defined by the Centers for Disease Control and Prevention (CDC) as pain lasting longer than 3 months, is a prevalent symptom of multiple sclerosis (MS). In fact, 50% to 75% of people living with MS suffer from chronic pain. Pain can be neuropathic, stemming from nerve damage, or musculoskeletal due to muscle spasms and joint damage or stress.

Although opioids are often prescribed in the United States to treat chronic pain, the CDC’s 2022 Clinical Practice Guideline for Prescribing Opioids for Pain does not recommend their use as first-line therapy for chronic pain. There is limited evidence of their long-term effectiveness in alleviating chronic pain, and their prolonged use has been associated with a myriad of negative outcomes, including increased risk for opioid use disorder, unintentional overdose, falls that may lead to fractures and myocardial infarction.

Aaron P. Turner, Ph.D.

Against this backdrop, a research team led by Aaron P. Turner, Ph.D. at the University of Washington in Seattle, sought to identify risk factors associated with chronic prescription opioid use in patients with MS. Turner and his colleagues conducted a retrospective longitudinal cohort study analyzing data obtained from the U.S. Department of Veterans Affairs of patients diagnosed with MS before 2017 and who received treatment at the Veteran’s Health Administration from 2015 to 2017. The study results were published earlier this month in the Archive of Physical Medicine and Rehabilitation.

A total of 14,974 participants with MS were included. The mean age was 58 years, 92% were non-Hispanic, 73.5% were White, 54.5% were married, and 66.7% lived in urban areas. Additionally, 62.2% had been diagnosed with a pain condition, and 39.3% had a history of depression.

Overall, prescription opioid use decreased from 2015 to 2017 (27.3% versus 22.9%). Chronic prescription opioid use (defined as lasting 90 days or longer) also declined during the three study years (14.6% versus 12.2%). However, the researchers found that over half of all annual prescription opioid use was identified as chronic.

The strongest risk factor for chronic opioid use was chronic prescription opioid use the previous year. Patients with chronic prescription opioid use in 2016 were almost 200 times more likely to have chronic opioid use in 2017 compared with participants without a history of chronic prescription opioid use. Other risk factors identified included living in rural areas, having a history of a pain condition, paraplegia or hemiplegia, and post-traumatic stress disorder. On the other hand, having a history of dementia and psychotic disorder reduced the risk of chronic prescription opioid use.

The study authors conclude, “Despite reductions over time, chronic prescription opioid use remains common among a substantial minority of veterans with MS and is associated with multiple biopsychosocial factors that are important for understanding risk for long-term use.” They added, “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.”