Determinants and Effectiveness of Nonpharmacologic Pain Interventions Versus Prescription Opioids

The three aims of this dissertation were to (i) describe annual trends in the use nonpharmacologic versus pharmacologic pain treatments, (ii) identify which social determinants of health predict access to opioid pain treatments and low-risk alternatives, and (iii) inform clinical practice guidelines for postoperative pain management by demonstrating the benefits of early and high dose nonpharmacologic pain treatment after surgery. We used a national sample of U.S. adults to compare pain treatment trends from 2011 through 2019. Findings from Aim 1 indicated that the use of nonpharmacologic pain treatments became more common than prescription opioids beginning in 2015 among adults with chronic, but not surgical, pain. Secondary findings from Aim 1 suggested that disparities—based on race, education, and income—impeded access to pain treatments. The Agency for Healthcare Research and Quality’s annual National Healthcare Quality and Disparities Report identifies healthcare disparities in some types of primary care but does not monitor access to pain treatments. To complement this report, Aim 2 identified the social determinants of health that predicted access to prescription opioids alone, low-risk nonpharmacologic pain treatments, or neither treatment from 2016 through 2019. Findings from Aim 2 indicated that individuals who identified as Black or African vii American or adults residing in the U.S. South were about 40% less likely to access a nonpharmacologic pain treatment compared to opioids. Higher education nearly doubled the odds of accessing nonpharmacologic pain treatments, which may provide an avenue to reduce disparities via patient advocacy and health literacy initiatives. Aim 1 established that occupational therapy and/or physical therapy were the most commonly used nonpharmacologic treatment providers after surgery; however, these providers are not currently recommended in some postoperative pain management guidelines. Aim 3 used a sample of Texas Medicare beneficiaries with a lower extremity joint replacement and subsequent home health to demonstrate the effectiveness of an early and high dose of occupational therapy and/or physical therapy. Our findings suggested that a higher dose may provide better pain control and more independent function after home health discharge without a need for more opioids.

Name thesis:degree_name

Rehabilitation Science (Doctoral)

Discipline thesis:degree_discipline

Public Health

Grantor

The University of Texas Medical Branch at Galveston

Year dc:date.issued

2023

Author dc:creator

• Pritchard, Kevin Thomas

Advisor dc:contributor.advisor

• Baillargeon, Jacques

Committee members dc:contributor.committeemember

• Kuo, Yong-Fang
• Raji, Mukaila
• Lee, Wei-Chen
• Li, Chih-Ying
• Reistetter, Timothy

Language dc:language.iso

English

Handle dc:identifier.uri

https://hdl.handle.net/2152.3/12843

OAI identifier oai:identifier

oai:utmb-ir.tdl.org:2152.3/12843