Opioid Therapy in the Treatment of Chronic Pain Conditions in Germany

Background: Primarily used for treating malignant pain, opioids are recently applied forchronic non-tumor pain. For the lack of evidence based strategies from long-term studies,opioids are discussed controversially, esp. considering cost-benefit.Objectives: The purpose of this study is to evaluate characteristics in prescribing opioids fortumor and non-tumor pain conditions.Study design: Cost effectiveness study/observational studySetting/Methods: Health insurance data of a German statutory health insurance company(N = 6.800.000, data acquisition from 2006 to 2010) was evaluated by assigning opioidprescriptions to certain pain related diagnoses using CART (Classification And Regression Tree)segmentation analysis. Age- and gender-specificcharacteristics of prescriptions were calculated.Results: The number of prescriptions of opioid prescriptions increased linearly. Prescriptionsof mild opioids were decreasing for non-tumor pain, but increasing for tumor pain, while thenumber of prescriptions of strong opioids was increasing both for tumor and nontumor pain.Differences occurred in terms of duration and kind of the preferred substances, includingthe considerations of common contraindications (e.g. somatoform disorders). The majority ofstrong opioids being prescribed for non-tumor pain were fentanyl pain patches for 40 to 45year old males with average annual costs of 1833 Euros per patient. Out of 21000 patientswith somatoform pain disorder, 44.4% were treated with opioids (20.7% with mild, 23.7%with strong opioids).Limitations: The results did not consider if the opioid medication was actually taken bythe patients. Another difference in terms of representativeness might occur since the genderdistribution varies between the official statistical data and data collected by the health insurancecompany. Because of the acquisition of the data, no conclusions about possible correlation ofpain syndromes and educational and social classes are possible. Tumor patients who receivedan opioid prescription for non-tumor pain could not be excluded.Conclusions: While the overall expenditure of the health insurance companies increased,it remains unknown which patient is receiving a particular opioid medication. Prescribingbehavior was often not consistent with common indications and contraindications.Key words: Opioid therapy, chronic pain conditions