Obesity and the Receipt of Prescription Pain Medications in the US

Abstract

Background

Little is known about disparities in pain treatment associated with weight status despite prior research on weight-based discrepancies in other realms of healthcare and stigma among clinicians.

Objective

To investigate the association between weight status and the receipt of prescription analgesics in a nationally representative sample of adults with back pain, adjusting for the burden of pain.

Design

Cross-sectional analyses using the Medical Expenditure Panel Survey (2010–2017).

Participants

Five thousand seven hundred ninety-one civilian adults age ≥ 18 with back pain.

Main measures

We examine the odds of receiving prescription analgesics for back pain by weight status using logistic regression. We study the odds of receiving (1) any pain prescription, (2) three pain prescription categories (opioid only, non-opioid only, the combination of both), and (3) opioids conditional on having a pain prescription.

Key Results

The odds of receiving pain prescriptions increase monotonically across weight categories, when going from normal weight to obesity II/III, despite adjustments for the burden of pain. Relative to normal weight, higher odds of receiving any pain prescription is associated with obesity I (OR = 1.30 [95% CI = 1.04–1.63]) and obesity II/III (OR = 1.72 [95% CI = 1.36–2.18]). Obesity II/III is also associated with higher odds of receiving opioids only (OR = 1.53 [95% CI = 1.16–2.02]), non-opioids only (OR = 1.77 [95% CI = 1.21–2.60]), and a combination of both (OR = 2.48 [95% CI = 1.44–4.29]). Obesity I is associated with increased receipt of non-opioids only (OR = 1.55 [95% CI = 1.07–2.23]). Conditional on having a pain prescription, the odds of receiving opioids are comparable across weight categories.

Conclusions

This study suggests that, relative to those with normal weight, adults with obesity are more likely to receive prescription analgesics for back pain, despite adjustments of the burden of pain. Hence, the possibility of weight-based undertreatment is not supported. These findings are reassuring because individuals with obesity generally experience a higher prevalence of back pain. The possibility of over-treatment associated with obesity, however, may warrant further investigation.

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Correspondence to Virginia W. Chang MD, PhD.

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Conflict of Interest

Gawon Cho participated in all tasks involved in the production of the manuscript and had access to the data. She formulated the research question and conducted literature search, which provided the basis for the project. She also led the empirical analyses and organized the findings into the manuscript. Gawon Cho has nothing to disclose.

Virginia Chang supervised Gawon Cho’s work throughout the course of the project. She contributed to conceptualizing the research question, choosing the dataset, designing the empirical analyses, and interpreting the results. She also contributed substantially to writing the manuscript. Virginia Chang has nothing to disclose.

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Cho, G., Chang, V.W. Obesity and the Receipt of Prescription Pain Medications in the US. J GEN INTERN MED (2021). https://doi.org/10.1007/s11606-020-06581-9

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KEY WORDS

  • obesity
  • pain
  • health disparities
  • pain medicine
  • opioids