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2019 HSR&D/QUERI National Conference Abstract

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1154 — Menopausal Symptoms and Higher Risk Opioid Use in a National Sample of Women Veterans with Chronic Pain

Lead/Presenter: Carolyn Gibson,  San Francisco VA Health Care System
All Authors: Gibson CJ (San Francisco VA Health Care System; University of California, San Francisco), Gibson CJ (San Francisco VA Health Care System; University of California, San Francisco), Li Y (San Francisco VA Health Care System) Huang AJ (University of California, San Francisco) Rife, T (San Francisco VA Health Care System; University of California, San Francisco) Seal KH (San Francisco VA Health Care System; University of California, San Francisco)

Objectives:
The greatest increases in long-term opioid use and overdose mortality in recent years have been among midlife women. Common menopausal symptoms broadly affect health, well-being, and health care utilization in midlife, but their contribution to chronic pain management during this period is poorly understood. In this study, we examined relationships between menopausal symptoms and opioid use among midlife women with chronic pain.

Methods:
Cross-sectional analyses of national Veterans Affairs medical and pharmacy records (2014-2015) were conducted among women Veterans aged 45-64 with ?1 outpatient visit and chronic pain diagnoses on encounters spanning ?90 days in the observed period. Menopausal symptoms were defined as menopause-related diagnoses on ?2 encounters and/or menopausal hormone therapy use. Patterns of opioid use were categorized as long-term opioid use (prescribed oral opioids for ?90 days), high-dose opioid use ( > 50 mg average morphine equivalent daily dose), and opioids co-prescribed with central nervous system depressants (CNS; benzodiazepine and non-benzodiazepine sedative-hypnotics, gabapentin/pregabalin, muscle relaxants). Multivariable logistic regression models were used to examine associations between menopausal symptoms and opioid use, adjusting for demographic and clinical characteristics.

Results:
In this national sample of 104,984 midlife women Veterans with chronic pain (mean age 54.5, SD 5.4 years), 33% had evidence of menopausal symptoms, 51% were prescribed long-term opioids, 13% were prescribed high-dose opioids, and 35% were co-prescribed opioids and a CNS depressant. In multivariable analyses, menopausal symptoms were associated with long-term opioids (OR 1.55, 95% CI 1.51-1.59, p < .001), high-dose opioids (OR 1.29, 95% CI 1.24-1.34, p < .001), and opioid co-prescription (sedative-hypnotics OR 1.62, 95% CI 1.58-1.66, p < .001; gabapentin/pregabalin OR 1.59, 95% CI 1.55-1.63, p < .001; muscle relaxants OR 1.61, 95% CI 1.57-1.6 5, p < .001).

Implications:
Menopausal symptom may be an under-recognized indicator of risk among midlife women with chronic pain, influencing treatment decisions that enhance risk for opioid-related disability and mortality.

Impacts:
Safe and effective comprehensive care for midlife women with chronic pain should include recognition of the potential role of menopause in pain experience and management, and the possibility that pharmacological treatments for menopausal symptoms may inadvertently put women with chronic pain treated with opioids at increased risk for opioid misuse and overdose.