Opioid prescription rates are higher among some people with disabilities

When adults with spina bifida and cerebral palsy are given prescribed opioids, on average they receive much higher doses than people without these pediatric neurodevelopmental disorders, a new study has found.

Chronic pain is a common symptom of cerebral palsy and spina bifida, and adults with these conditions often take several medications a day. A previous study, for example, found that people with cerebral palsy and other neurodevelopmental disorders were 2.4 times more likely to take at least five medications a day than people without those conditions.

When one or more of these drugs are opioids such as oxycodone, hydrocodone or tramadol, patients may be at increased risk for addiction, overdose, psychiatric problems and respiratory problems, states the The study’s lead author, Mark Peterson, PhD, associate professor of physical medicine and rehabilitation at the University of Michigan Medical School in Ann Arbor.

“Apart from managing acute pain after surgery or managing cancer-related pain, opioids are dangerous for these populations,” says Dr. Peterson.

For the new study, researchers looked at private health insurance data on 22,647 patients with cerebral palsy or spina bifida and a control group of 931,528 people without these conditions.

Among people with chronic pain, patients with cerebral palsy and spina bifida were 79% more likely to be prescribed opioids, researchers reported in the journal. Heliyon. With isolated or temporary pain, people with these disabilities were 48% more likely to be prescribed opioids. And among those with no pain, patients with spina bifida and cerebral palsy were still 51% more likely to be prescribed opioids.

Adults with these disabilities also appeared to receive higher average doses of opioids. The researchers determined this based on an analysis of five years of data on opioid users in the study which looked at what are called ‘oral morphine equivalents’ (OME), a standardized way compare cumulative opioid use over time with different types of drugs.

People with spina bifida and cerebral palsy had total average annual OMEs of 8,981, about double those of people without those disabilities, according to the analysis. The difference was most pronounced – about 2.5 times greater for people with disabilities – in people who had no pain.

Alternatives to opioids could relieve pain without such dire consequences

A limitation of the study is that the results for people with private health insurance may not be representative of all patients, especially those uninsured or covered by government health plans like Medicaid or Medicare, writes the study team. Another limitation is that results for people with spina bifida and cerebral palsy may not reflect what happens for people with other types of disabilities, the researchers also point out.

Cerebral palsy is the most common childhood motor disability, affecting about 1 in 135 children in the United States, according to the Centers for Disease Control and Prevention (CDC). It is caused by abnormal brain development and can cause difficulty with walking and other motor skills.

Spina bifida is rarer, affecting about 1 in 2,758 babies born in the United States, according to the CDC. It is caused by defects in the neural tube – the precursor to the brain and spinal cord – when babies develop in the womb. People with spina bifida can have a wide range of physical or intellectual deficits, depending on which part of the brain and spinal cord is affected.

With both of these conditions, pain can develop as a result of a wide range of issues, including:

  • Muscle spasticity
  • Arthritis
  • Invasive surgical procedures

Since the study did not provide details about the potential causes or severity of patients’ pain, it is difficult to say whether or not opioid prescriptions or cumulative doses were appropriate, says Brad Dicianno, MD, Director of the Adult Spina Bifida Clinic at the University of Pittsburgh Medical Center in Pennsylvania, and Associate Medical Director and Chair of the Professional Advisory Board of the Spina Bifida Association.

“The suitability of a specific pain reliever and the dose depends on each specific patient case,” says Dr. Dicianno. “However, there are a variety of analgesic options in addition to opioids that may be beneficial in certain pain conditions in this population.”

Alternatives to opioids can include over-the-counter medications like ibuprofen, acetaminophen, aspirin, or steroids, according to the American Society of Anesthesiologists (ASA). Injections or nerve blockers can treat muscle spasms or nerve pain, and other options such as physical therapy or acupuncture can sometimes help, the ASA notes.

“Pain can also be treated in different ways without the use of oral medications,” says Dicianno.

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