Presentation Authors: Bryan Wilson*, Anthony Smith, Glen Murata, Allison Murata, Clifford Qualis, Sara Cichowski, Albuquerque, NM
Introduction: To compare chronic narcotic use (CNU) and average narcotic doses prescribed five years prior to and five years following the diagnosis of chronic pelvic pain (CPP). To evaluate patient characteristics associated with CNU and CPP.
Methods: We used the validated Veteranâ€™s Health Administration corporate database warehouse. Time 0 was the first CPP diagnosis date by ICD-9 codes. Outpatient narcotic prescriptions were summed for the 5 years preceding and following CPP diagnosis; oral narcotics were converted to morphine equivalents (ME). CNU was defined as greater than 90 narcotic use days per year; drug abuse/overdose rates were defined by ICD-9 codes. An interrupted time series analysis was performed to model the impact of CPP on CNU.
Results: 168,318 male Veterans met inclusion criteria of non-cancer CPP diagnosed between 2002-2012 with average age of 59.9 Â± 14.1years; 17.9% of minority race, with an average BMI of 29.2Â± 5.4kg/m2 and 2.3% had a history of military sexual trauma. Other chronic pain conditions were common at baseline with 7.0% (n=11762) diagnosed with fibromyalgia, 16.5% (n=27828) with back pain and 14.2% (n=23938) with chronic headaches. _x000D_
Five years prior to CPP diagnosis, 8.7% of men were prescribed CNU. Five years following diagnosis, CNU increased to 18.1% (or 11,053 men, p < 0.001). The interrupted time series analysis data is presented in Figure 1. Average narcotic doses increased from 31.1 to 41.1mg ME per dose (p < 0.01). Risk factors for becoming a CNU included smoking (OR 1.7 95% CI 1.6, 1.7), fibromyalgia (OR 1.5, 95% CI 1.5, 1.6) back pain (OR 1.5 95% CI 1.5, 1.6) and headaches (OR 1.4 95% CI 1.4, 1.6). In this cohort, 13.8% (n=21506) were diagnosed as drug abusers and 2.7% (n=4255) had an overdose.
Conclusions: The diagnosis of CPP is associated with increased and sustained use of chronic opioids. Male Veterans who smoke and also carry diagnoses of headaches, fibromyalgia or back pain are particularly at risk
Source of Funding: This study was supported by a grant from the Biomedical Research Institute of New Mexico. Study approval by IRB 15-H175