Menopausal Symptoms and Higher Risk Opioid Prescribing in a National Sample of Women Veterans with Chronic Pain
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The greatest increases in long-term opioid use and opioid-related overdose mortality in recent years have been among women in midlife. Common menopausal symptoms broadly affect health and health care utilization in midlife, but their contribution to chronic pain management during this period is unknown.
To examine relationships between menopausal symptoms and long-term opioid prescription patterns among midlife women with chronic pain.
Cross-sectional analysis of national Veterans Health Administration medical and pharmacy records (2014–2015).
Women Veterans aged 45–64 with ≥ 1 outpatient visit and chronic pain diagnoses spanning ≥ 90 days.
Long-term opioids (prescribed oral opioids for ≥ 90 days), high-dose long-term opioids (> 50 mg average morphine equivalent daily dose), and long-term opioids co-prescribed with central nervous system depressants (benzodiazepine and non-benzodiazepine sedative-hypnotics, gabapentin/pregabalin, muscle relaxants). Multivariable logistic regression models were used to examine associations between outcomes and menopausal symptoms (menopausal symptom–related diagnoses (i.e., “symptomatic menopausal states”) on ≥ 2 encounters and/or menopausal hormone therapy, adjusting for race, age, body mass index, and mental health and substance use disorder diagnoses.
In this national sample of 104,984 midlife women Veterans with chronic pain (mean age 54.5, SD 5.4 years), 17% had evidence of menopausal symptoms, 51% were prescribed long-term opioids, 13% were prescribed high-dose long-term opioids, and 35% were co-prescribed long-term opioids and central nervous system depressants. In multivariable analyses, women with menopausal symptoms had increased odds of long-term opioids (OR 1.21, 95% CI 1.18–1.26), high-dose long-term opioids (OR 1.08, 95% CI 1.02–1.13), and long-term opioids co-prescribed with central nervous system depressants (sedative-hypnotics OR 1.25, 95% CI 1.22–1.30; gabapentin/pregabalin OR 1.23, 95% CI 1.20–1.27; muscle relaxants OR 1.24, 95% CI 1.20–1.28).
Among midlife women Veterans with chronic pain, evidence of menopausal symptoms was associated with potentially risky long-term opioid prescription patterns, independent of known risk factors.
KEY WORDSwomen’s health menopause opioids chronic pain Veterans
CJG and KHS were responsible for the study concept and design. KHS obtained funding and supervised the study. YL conducted the statistical analysis. All authors were involved in the interpretation of data. CJG drafted the manuscript, and all authors critically revised it for important intellectual content and approved the final version. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. CJG is the guarantor and accepts overall responsibility for the accuracy of the data, its analysis, and this report.
No additional data are available owing to a data use agreement with the Department of Veterans Affairs.
This research was supported, in part, by the U.S. Department of Veterans Affairs Quality Enhancement Research Initiative (VA QUERI), “Evaluation of the Implementation of the Integrated Pain Team Clinic” (KHS, YL); CJG was supported by the VA Advanced Fellowship Program in Women’s Health at the San Francisco VA Health Care System and VA Health Services Research & Delivery CDA IK2 HX002402 during the conduct of this study.
Compliance with Ethical Standards
The study was approved by the institutional review boards of the University of California, San Francisco, and the Research and Development Committee of the San Francisco VA Health Care System.
Conflict of Interest
AH has received research grants from Pfizer Inc. and Astellas through the University of California, San Francisco to conduct research unrelated to this manuscript. All remaining authors declare that they do not have a conflict of interest.
The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation or approval of the manuscript; or the decision to submit the manuscript for publication. The views expressed herein are those of the authors and do not necessarily represent the views of the US Department of Veterans Affairs or the University of California, San Francisco.
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