Guideline-Noncompliant Opioids Prescribed for Many With Diabetic Peripheral Neuropathy

Despite fewer patients newly diagnosed with diabetic peripheral neuropathy (DPN) being started on pain medications, nearly 43% of them were prescribed guideline-noncompliant opioids between 2014 and 2018. These findings from a retrospective cohort study were published in JAMA Network Open.

Electronic health records from the Mayo Clinics located in Arizona, Florida, and Minnesota were analyzed for this study. Researchers examined the records of patients (N=3495) with a new diagnosis for DPN to determine the medications prescribed after they received their diagnosis, and these medications were then compared with medications prescribed for them during the preceding 12 months. Treatment plans were compared with guideline recommendations for DPN management.

Patients were 60.2% men, their ages were mostly in the range of 45 to 64 (35.2%) or 65 to 72 (32.0%) years, and 89.8% were White.

After receiving their DPN diagnosis, 40.2% were prescribed a new pain medication. The trend over time was that fewer patients in 2018 were prescribed a new pain medication (35.2%) than in 2014 (45.6%), and in general, prescriptions of nonopioids have increased and those of opioids have decreased over the study period.

Patients were more likely to receive a new pain medication prescription if they had comorbid depression (odds ratio [OR], 1.61; 95% CI, 1.35-1.93; P <.05), back pain (OR, 1.34; 95% CI, 1.16-1.55; P <.05), or arthritis (OR, 1.21; 95% CI, 1.02-1.43; P <.05).

Among patients who received a new prescription, 43.8% were prescribed opioids and 42.9%, guideline-recommended drugs.

Opioid use was more likely among men (OR, 1.26; 95% CI, 1.01-1.59; P <.05). Guideline-compliant medications were given less often to patients with comorbid arthritis (OR, 0.76; 95% CI, 0.59-0.99; P <.05).

These findings may have been biased by the choice to include all patients, even those who had preexisting mood or pain conditions that may be associated with opioid use.

These findings suggested that among patients with DPN, although fewer patients were receiving a prescription in recent years, many still were receiving prescriptions for opioids, which did not comply with current guidelines for DPN management.

Reference

Fan J, Jeffery MM, Hooten WM, Shah ND, McCoy RG. Trends in pain medication initiation among patients with newly diagnosed diabetic peripheral neuropathy, 2014-2018. JAMA Netw Open. 2021;4(1):e2035632. doi:10.1001/jamanetworkopen.2020.35632