Trends in Opioids and Nonpharmacologic Pain Management Among U.S. Cancer Survivors, 2011-2020

Objective: It is unknown how the United States (U.S.) opioid epidemic influenced the integration of nonpharmacologic pain treatments in cancer survivors. We described annual trends and predictors of using opioids alone, nonpharmacologic treatments alone, multimodal treatments (opioid + nonpharmacologic), and neither treatment. Design: A serial cross-sectional design. Setting: Ambulatory. Participants: Noninstitutionalized U.S. adults with prevalent cancer and pain in the Medical Expenditure Panel Survey (2011-2020). Interventions: Not applicable. Main Outcome Measures: Period prevalence of self-reported and pharmacy-verified use of opioids alone, nonpharmacologic treatments alone, both, or neither. Nonpharmacologic treatments included physical therapy, occupational therapy, chiropractic care, massage therapy, and acupuncture. Results: Respondents with cancer and pain represented a total of 41,064,668 adults from 2011 to 2020. Most adults with cancer pain were >65 years of age (66.6%), women (52.1%), White (91.4%), non-Hispanic (95.8%), had a high school diploma (42.2%), had an income of 400% of the federal poverty line (46.6%), and lived in the U.S. South (37.7%). Compared with 2011, the prevalence of multimodal treatments increased from 4% (95% confidence interval [CI], 2%-6%) to 10% (95% CI, 6%-14%) in 2019, while the prevalence of using neither pain treatment decreased from 62% (95% CI, 55%-68%) to 46% (95% CI, 40%-52%). Compared with using neither treatment, the adjusted relative risk ratio (RRR) for using nonpharmacologic treatments was stable from 2011 to 2015 (RRR=1.00; 95% CI, 0.93-1.08), but increased from 2016 to 2019 (RRR=1.22; 95% CI, 1.02-1.46) until 2020 (RRR=0.68; 95% CI, 0.43-1.46). Both unadjusted and adjusted analyses found that pain treatments varied based on income, educational attainment, race, and geographic region. Conclusions: Nonpharmacologic and multimodal pain treatments increased from 2011 to 2020; however, most cancer pain survivors remained untreated. Pain treatment varied based on sociodemographic and socioeconomic factors.