Chronic pain among patients with opioid use disorder: Results from electronic health records data

May combine two claims.

OUD First had the highest HCV rate (28.2%), followed by No Pain (17.8%), Same Time (16.1%), and Pain First (15.8%).

“The OUD First group also showed the highest rate of HCV (28.2%), followed by the No Pain group (17.8%), Same Time group (16.1%), and the Pain First group (15.8%).”

May combine two claims.

Pain First and Same Time patients had the highest rate of sedative/hypnotic/anxiolytic use and the lowest rates of alcohol, cannabis, amphetamine, cocaine, and hallucinogen use disorders.

“The highest rate of sedative/hypnotic/anxiolytic use but lowest rates of alcohol, cannabis, amphetamine, cocaine, and hallucinogen use disorders were found in the Pain First group and the Same Time group.”

May combine two claims.

The four groups significantly differed in prevalence of any mental disorder or each specific type of mental disorder (p < 0.01), with psychotic disorder as the only exception.

“the four groups also significantly differed in prevalence of any mental disorder or each specific type of mental disorder (p < 0.01) with only one exception, psychotic disorder.”

May combine two claims.

The OUD sample was distributed as 35.6% No Pain, 9.7% OUD First, 14.9% Same Time, and 39.8% Pain First.

“35.6% were No Pain, 9.7% were OUD First, 14.9% were Same Time, and 39.8% were Pain First.”

May combine two claims.

No Pain patients had the highest rate of amphetamine use and the lowest rate of tobacco use.

“The No Pain group had the highest rate of amphetamine use and the lowest rate of tobacco use.”

May combine two claims.

Liver disease rates were 15.9% in Pain First, 14.1% in No Pain, 24.5% in OUD First, and 15.1% in Same Time.

“liver diseases (15.9% vs. 14.1% vs. 24.5% vs. 15.1%)”

The quote only partly states this claim.

The Pain First group consistently had the highest rates of mental disorders.

“with the highest rates consistently among the Pain First group.”

May combine two claims.

OUD First patients generally had higher rates of other substance use disorders, similar to rates in the No Pain group.

“The OUD First group generally had higher rates of other substance use disorders, commensurate with rates in the No Pain group.”

May combine two claims.

The study cohort comprised 5,307 OUD patients drawn from a healthcare system with 4.6 million patients.

“The study cohort included 5,307 patients who had OUD, out of the 4.6 million patients in the system.”

May combine two claims.

Among the four groups, OUD First had the highest HIV rate (4.7%), while the other two groups had similar rates (1.7-2.7%).

“Among the four groups, the OUD First group had the highest HIV rate (4.7%), with the other two groups having a similar rate (1.7–2.7%).”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Most study patients were male, white, and had private insurance or paid for care themselves.

“Most study patients were male, white, and most had private insurance or paid for care themselves (Table 1).”

May combine two claims.

The majority of patients (76.4%) in this general healthcare setting were white and had private insurance or resources to pay for care.

“the majority of patients (76.4%) in this general healthcare or medical setting were white and with private insurance or the resources to pay for their healthcare”

May combine two claims.

Prevalence rates of these major pain diagnoses were significantly different among the three chronic pain groups (p < .01), and were higher in Pain First than in OUD First or Same Time (p < .05).

“The prevalence rates in all these diagnoses were significantly different among the three groups with chronic pain (p < .01), and these rates were higher among the Pain First group than among the OUD First or Same Time groups (p < .05).”

May combine two claims.

Compared with other groups, No Pain patients were younger, fewer were employed, and more paid for care.

“Relative to the other groups, patients in the No Pain group were younger, fewer were employed, and more paid for care.”

May combine two claims.

Participants were predominantly white patients living in Los Angeles, which may limit generalizability to patients in other regions.

“Participants were predominantly white patients living in the Los Angeles area of the United States, potentially limiting generalizability to patients in other regions.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Variation in physician documentation and health insurance requirements may introduce bias in the data captured.

“variation in physician documentation and health insurance requirements may introduce bias in the data that are captured.”

Classified as probably not a substantial claim.

Separate multinomial logistic regression analyses tested group differences for each diagnostic measure, controlling for age, race, gender, and length of observation.

“Separate multinomial logistic regression analyses were conducted for each diagnostic measure to test group differences (using the No Pain group as the reference), controlling for age, race, gender, and length of observation.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Studies of healthcare claims data show that the most challenging and costliest OUD patients had high rates of preexisting and concurrent medical comorbidities and mental health disorders.

“Similarly, studies of healthcare claims data reveal that the most challenging and costliest OUD patients had high rates of preexisting and concurrent medical comorbidities and mental health disorders (Shei et al., 2015).”

• cites Shei et al., 2015 sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Rates of co-occurring chronic pain (64.4%) and mental disorders (70.9%) appear higher than most rates reported in the literature for OUD, often heroin use disorder, treated in public settings.

“Somewhat surprising is that the rates of co-occurring chronic pain conditions (64.4%) and mental disorders (70.9%) appear even higher than most rates reported in the literature in connection with OUD, often heroin use disorder, treated in public settings.”

• AssumptionRests on an assumption: Most knowledge of OUD, including medical conditions among patients in publicly funded programs, is based on self-reports from individuals treated in publicly funded addiction specialty programs.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Clinical data were initially recorded for clinical reasons rather than research, so their accuracy may be lower than research data.

“The clinical data were initially recorded for clinical reasons and not specifically for research purposes, so the accuracy of the data may be less than that collected for research purposes.”

Classified as probably not a substantial claim.

Because the four groups differed significantly in age, race, and gender, these measures were included as controls in subsequent analyses.

“Given that the four groups differed significantly in age, race, and gender, these measures were included in subsequent analyses as controls.”

Classified as probably not a substantial claim.

Chronic pain codes followed the list provided by the Centers for Disease Control and Prevention.

“Codes for conditions that cause chronic pain follow the list provided by the Centers for Disease Control and Prevention (CDC, 2013).”

• cites CDC, 2013Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Comorbid OUD and chronic pain complicates treatment decision-making, predicts poor outcomes, and increases healthcare costs.

“Comorbid OUD and chronic pain complicates treatment decision-making, predicts poor outcomes, and increases healthcare costs (Trafton, Oliva, Horst, Minekl, & Humphreys, 2004).”

• cites Trafton, Oliva, Horst, Minekl, & Humphreys, 2004Not checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

ICD-9 codes for pain-related, psychiatric, and physical health domains were determined by extensive literature review, CMS documents, and expert reviews.

“For each of these domains, ICD-9 codes were determined by an extensive review of the literature providing relevant ICD-9 codes, searching and confirming with documents provided by the Centers for Medicare & Medicaid Services (CMS), and expert reviews.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Mislabeling of people without OUD and under-recognition of true OUD could affect the true prevalence of OUD in the sample.

“Both mislabeling of people who do not actually have OUD and under-recognition of true OUD diagnoses could affect the true prevalence of OUD in the sample.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Because addiction can be under-recognized in the EHR, some patients in the Pain First group may actually belong in the OUD First group.

“Since addiction can be under-recognized in the EHR, it is possible that a subset of patients may not have been identified as having an OUD; thus, there may be some patients in the Pain First group that may actually belong in the OUD First group.”

May combine two claims.

The study lacked information about patient diagnoses outside the system and could not ascertain a new OUD diagnosis except as the first OUD diagnosis in the healthcare system.

“we do not have the information about patient diagnoses outside the system in our study and therefore are unable to ascertain the new OUD diagnosis except that it’s the first OUD diagnosis in the healthcare system under study.”

May combine two claims.

OUD is similarly associated with high or even higher morbidity among patients in the private sector as in the public sector, putting them at high risk for mortality.

“This study demonstrated that regardless of demographic differences, OUD is similarly associated with high (or even higher) morbidity among patients in the private sector as in the public sector, which put them at high risk for mortality.”

• AssumptionRests on an assumption: Most knowledge of OUD, including medical conditions among patients in publicly funded programs, is based on self-reports from individuals treated in publicly funded addiction specialty programs.

Classified as probably not a substantial claim.

Length of observation was included as an additional control to avoid potential bias from differential observation periods across groups.

“To avoid potential bias due to differential observation periods by the four groups, the length of observation (first visit to last visit, as indicated by the records) was also included as an additional control variable.”

Classified as probably not a substantial claim.

The findings depend on the extent, accuracy, and validity of the EHR data.

“Our findings are dependent on the extent, accuracy, and validity of the data available in the EHR dataset.”