Prescribing Practices Improving, But Opioids Still Prescribed at High Rate for Diabetic Neuropathy

A retrospective analysis of EHR data from 3 Mayo Clinic facilities details prescribing practices for pain medications among patients with newly diagnosed diabetic peripheral neuropathy.

New research from a Mayo Clinic-led team of physicians found the initiation of pain medication for newly diagnosed diabetic peripheral neuropathy has dropped by more than a third since 2014, but also found rates of opioid prescribing remain high.

A retrospective look at data from 2014-2018, results of the study indicate 43.8% of patients who initiated pain management for diabetic peripheral neuropathy were prescribed opioids, which investigators noted exceeds estimates provided by previous studies.

“Such high rates of opioid use by patients with DPN, a lifelong pain syndrome, are concerning because safer effective treatment options are available,” noted investigators.

Commonly referred to as diabetic nerve pain, some previous research suggests half of all patients with diabetes will develop this condition. This knowledge, combined with information from more recent studies suggesting up to half of all patients with diabetic peripheral neuropathy experience some level of pain, led investigators to examine trends in treatment as part of an effort to promote safe, evidence-based pain management in this population.

The current study was designed as a retrospective cohort study using electronic health record data from Mayo Clinic facilities in Minnesota, Arizona, and Florida. Choosing 2014-2018 as a study period, investigators evaluated first-line analgesic medications prescribed to adults with a new diagnosis of diabetic peripheral neuropathy.

Investigators noted their study was limited by the inability to examine the clinical context of pain management, the sample size could have led to the study being underpowered, and their data did not capture the duration of opioid treatment. Of note, included medications were prescribed fudging the first year after diagnosis sand had not been prescribed in the 12 months before diagnosis for nonopioids or 3 months for opioids.

Medications identified as part of the investigators' query were classified as guideline-recommended, opioids, and acceptable medications. Guideline recommended medications included pregabalin, gabapentin, and serotonin-norepinephrine reuptake inhibitors and acceptable medications were defined as topical analgesics, tricyclic antidepressants, and other anticonvulsants.

During the aforementioned time period, investigators identified 3495 patients with newly diagnosed diabetic peripheral neuropathy, of which 1406 began a new pain medication after diagnosis. When comparing 2014 to 2018, results indicated adjusted odds of starting a new pain medication decreased by 35%, with a rate of 45.6% in 2014 and 35.2% in 2018.

Further analysis indicated the most common conditions associated with a new pain medication was depression (OR, 1.61; 95% CI, 1.35-1.93) arthritis (OR, 1.21; 95% CI, 1.02-1.43), and back pain (OR, 1.34; 95% CI, 1.16-1.55), but investigators pointed out these decreased significantly over time.

Of 1406 who began a new pain medication, 616 (43.8%) were prescribed opioids, 603 (42.9%) were prescribed a guideline-recommended medication, and 289 (20.6%) were prescribed an acceptable medication. When assessing factors associated with receiving a prescription for opioids, results indicated male sex was associated with greater odds and the presence of fibromyalgia was associated with lesser odds of receiving such a prescription. Additionally, comorbid arthritis was associated with decreased odds of recommended medication use.

This study, “Trends in Pain Medication Initiation Among Patients With Newly Diagnosed Diabetic Peripheral Neuropathy, 2014-2018,” was published in JAMA Network Open.