Prescription pain medication use for diabetic peripheral neuropathy decreased in recent years, though opioids accounted for over 40% of these scripts, a retrospective study found.

Looking at data on 3,496 adults with newly diagnosed diabetic peripheral neuropathy, the percentage of patients who received a new prescription for pain medication dropped from 46% in 2014 to 35% in 2018, Rozalina McCoy, MD, MS, of the Mayo Clinic in Rochester, Minnesota, and colleagues wrote in JAMA Network Open.

Drawing on electronic health record data from Mayo Clinics in Minnesota, Arizona, and Florida, the study included patients who were prescribed a first-line analgesic medication with a new ICD-10 diagnosis of diabetic peripheral neuropathy.

Among those starting a new pain medication, 44% were prescribed opioids during the study period, which are not recommended for diabetic peripheral neuropathy pain according to clinical guidelines.

“The use of any opioids for management of chronic neuropathic pain carries the risk of addiction and should be avoided,” the 2020 Standards of Medical Care in Diabetes from the American Diabetes Association advises.

Opioids made up roughly half of pain prescriptions in 2014 to just over 40% in 2018. For those prescribed opioids, patients were more likely to be male and were also less likely to have fibromyalgia.

“Such high rates of opioid use by patients with DPN [diabetic peripheral neuropathy], a lifelong pain syndrome, are concerning because safer effective treatment options are available,” McCoy’s group underscored.

They also pointed out that the rates of opioid use seen here “exceeded those reported previously, likely because we did not exclude patients with preexisting pain or mood disorders, which are common in this population, making our study findings more generalizable.”

On the other hand, 43% of those who were started on a pain medication were prescribed one of the guideline-recommended agents: pregabalin (Lyrica), gabapentin (Neurontin, Gralise, Neuraptine), or serotonin-norepinephrine reuptake inhibitors such as venlafaxine (Effexor XR), duloxetine (Cymbalta), milnacipran (Savella), and desvenlafaxine (Pristiq).

About one in five patients were prescribed an “acceptable” medication for diabetic peripheral neuropathy, which included topical analgesics, tricyclic antidepressants, and other anticonvulsants.

Although prescriptions for opioids appeared to taper from 2014 to 2018 (OR 0.71, 95% CI 0.49-1.02) and use of recommended medications increased slightly (OR 1.25, 95% CI 0.86-1.80), these trends weren’t statistically significant after adjusting for both demographic and other clinical factors.

Certain clinical factors were tied to a higher chance of patients starting a new pain medication.

Comorbid depression was the top condition tied to a higher chance of starting a new prescription, increasing the odds by 61% (OR 1.61, 95% CI 1.35-1.90), followed by comorbid arthritis (OR 1.21, 95% CI 1.02-1.43) and back pain (OR 1.34, 95% CI 1.16-1.55).

Interestingly, patients who had comorbid arthritis were about 24% less likely to be prescribed one of the recommended pain medications for diabetic peripheral neuropathy (OR 0.76, 95% CI 0.59-0.99).

However, new prescriptions for all these patients significantly dropped off from 2014 to 2018.

Presence of diabetes-related complications — retinopathy, nephropathy, cardiovascular disease, cerebrovascular disease, peripheral vascular disease — was not tied to an increased chance of starting a new pain medication.

One limitation of the study was a lack of data on pain severity and if patients had any other indication for opioid treatment.

“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,” the group concluded.

Kristen Monaco is a staff writer, focusing on endocrinology, psychiatry, and dermatology news. Based out of the New York City office, she’s worked at the company for nearly five years.

This study was funded by a grant from the the National Institute of Diabetes and Digestive and Kidney Diseases.

McCoy reported grants from the AARP Quality Measure Innovation program through a collaboration with OptumLabs and the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. Other disclosures were also reported.

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