Reimbursement of analgesics for chronic pain

Tidsskr Nor Laegeforen. 2012 Nov 27;132(22):2489-93. doi: 10.4045/tidsskr.11.1214.
[Article in English, Norwegian]

Abstract

Background: The prevalence of chronic non-malignant pain in Norway is between 24% and 30%. The proportion of the population using opioids for non-malignant pain on a long-term basis is around 1%. The purpose of our study was to investigate how many were prescribed analgesics on reimbursable prescription under reimbursement code -71 (chronic non-malignant pain) in 2009 and 2010, which analgesics were prescribed and whether prescribing practices were in accordance with national guidelines.

Material and method: We retrieved pseudonymised data from the National Prescription Database on all those who received drugs with reimbursement code -71 in 2009 and 2010. The data contain information on drug, dosage, formulation, reimbursement code and date of issue.

Results: 90,731 patients received reimbursement for drugs indicated for chronic non-malignant pain in 2010. Of these, 6,875 were given opioids, 33,242 received paracetamol, 25,865 non-steroid inflammatory drugs (NSAIDs), 20,654 amitryptiline and 16,507 gabapentin. Oxycodone was the most frequently prescribed opioid, followed by buprenorphine, tramadol and codeine/paracetamol. Of those who were prescribed opioids, 4,047 (59%) received mainly slow-release opioids, 2,631 (38%) also received benzodiazepines and 2,418 (35%) received benzodiazepine-like sleep medications.

Conclusion: The number of patients who received analgesics and opioids on reimbursable prescriptions was low compared to the proportion of the population with chronic pain and the proportion using opioids long-term. 38% of those reimbursed for opioids also used benzodiazepines, which is contrary to official Norwegian guidelines.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Analgesics / administration & dosage
  • Analgesics / economics
  • Analgesics / therapeutic use
  • Analgesics, Opioid / administration & dosage
  • Analgesics, Opioid / adverse effects
  • Analgesics, Opioid / economics
  • Analgesics, Opioid / therapeutic use*
  • Benzodiazepines / administration & dosage
  • Benzodiazepines / adverse effects
  • Benzodiazepines / economics
  • Benzodiazepines / therapeutic use
  • Chronic Pain / drug therapy*
  • Chronic Pain / epidemiology
  • Drug Prescriptions / economics
  • Drug Prescriptions / statistics & numerical data*
  • Drug Therapy, Combination / adverse effects
  • Drug Utilization / economics
  • Drug Utilization / statistics & numerical data*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Norway / epidemiology
  • Practice Guidelines as Topic
  • Prescription Drugs / administration & dosage
  • Prescription Drugs / economics
  • Prescription Drugs / therapeutic use
  • Registries
  • Reimbursement Mechanisms*

Substances

  • Analgesics
  • Analgesics, Opioid
  • Prescription Drugs
  • Benzodiazepines