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2015 HSR&D/QUERI National Conference Abstract

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3063 — Changes in pain intensity and pain treatment utilization in Veterans following discontinuation of long-term opioid therapy

Lovejoy TI, VA Portland Health Care System; Meath TH, VA Portland Health Care System; Morasco BJ, VA Portland Health Care System; Demidenko MI, VA Portland Health Care System; Dobscha SK, VA Portland Health Care System;

Objectives:
An increasing number of Veterans Health Administration (VHA) patients prescribed long-term opioid therapy are discontinuing opioid therapy, particularly among Veterans with substance use disorder (SUD) diagnoses, yet little is known about pain intensity and pain treatment utilization subsequent to opioid discontinuation. The objectives of this study were to examine and compare changes in pain intensity and pain treatment utilization following discontinuation of long-term opioid therapy among Veterans with and without SUDs.

Methods:
All data for this retrospective cohort study were obtained from the VHA Corporate Data Warehouse. The study population comprised all VHA patients prescribed continuous opioid therapy for all of fiscal year 2011 who subsequently discontinued opioid therapy for at least 12 consecutive months beginning in fiscal year 2012. Eligible Veterans had one or more Numeric Rating Scale pain intensity scores in the electronic medical record both in the years prior to and following opioid discontinuation.

Results:
A total of 2,363 Veterans were included in the study (746 with and 1,622 without SUD diagnoses in FY 2011). Prior to opioid discontinuation, Veterans with a SUD had higher opioid doses, average pain intensity scores, and rates of pain treatment utilization compared with Veterans without a SUD (all p < 0.01). In the year following opioid discontinuation, Veterans, regardless of SUD diagnosis, evidenced increased pain treatment utilization including physical medicine and rehabilitation, physical therapy, occupational therapy, and specialty pain care) and slight reductions in pain intensity (all p < 0.01). Compared to Veterans without a SUD, Veterans with a SUD continued to have higher average pain intensity scores and pain treatment utilization in the year following opioid discontinuation (all p < 0.01). Multivariable logistic regression analyses indicated that greater primary care utilization without concomitant pain treatment during opioid therapy was associated with an increased probability of pain treatment utilization in the year following opioid discontinuation (OR = 1.03, 95% CI = 1.00-1.05).

Implications:
Following long-term opioid therapy discontinuation, Veterans with and without SUD diagnoses who continue to receive VA care report less pain intensity, while increasing utilization of pain treatment services.

Impacts:
Engaging Veterans in non-opioid pain therapies following long-term opioid therapy discontinuation may sustain and even further improve pain outcomes.