Analysis Finds Differences in Chronic Pain Treatment by Type of Health Insurance

An analysis of medical claims data suggests that adults experiencing new episodes of chronic pain may have differential access to all treatment options based on the type of health insurance they have. Recently published in The Journal of Pain, the study was conducted by researchers at the U.S. Centers for Disease Control and Prevention (CDC) and the National Center for Complementary and Integrative Health.

Chronic pain is considered a sensitive barometer of population health. It affects a large part of the U.S. adult population and has been estimated to cost $560 to $635 billion annually (in 2010 dollars). The current 2022 CDC Clinical Practice Guideline encourages clinicians to evaluate the full range of evidence-based pharmacologic and nonpharmacologic options for pain treatment while also considering patient values and preferences. However, health insurance coverage and reimbursement policies do not always align with these guidelines, possibly preventing adequate care. Analyzing health care data can show how chronic pain is treated and identify possible opportunities for change.

In this retrospective cohort study, after identifying patients who had been newly diagnosed with conditions associated with chronic pain, researchers compared treatments received by the patients according to their type of health insurance. Among 4,254,818 adults with commercial insurance and 583,369 adults with Medicaid insurance who had not experienced chronic pain in 2017, researchers identified 1,095,358 adults with commercial insurance and 176,607 adults with Medicaid insurance who experienced new episodes of chronic pain during the 2018–2020 timeframe. 

The analysis found no differences between the two groups of adults in the proportion with new episodes of chronic pain or specific types of pain, with the most common types being limb/joint, back, and abdominal/bowel pain. But the findings did show that the type of health insurance was associated with differences in the provision, patterns, and timing of treatment for chronic pain. 

Overall, the study indicated that more commercially insured patients than Medicaid-insured patients received restorative therapies (e.g., physical therapy), complementary or integrative care (e.g., chiropractic treatment), and two or more different types of nonmedication treatments. For instance, more patients with commercial insurance (38.6 percent) received restorative therapies than patients with Medicaid (19.2 percent), and the median time from diagnosis to treatment was 47 days for those with commercial insurance but 97 days for those with Medicaid. Similarly, more patients with commercial insurance (31.1 percent) received complementary care than those with Medicaid (9.0 percent), and the median time from diagnosis to treatment was shorter for those with commercial insurance (36 days) than those with Medicaid (76 days). Also, 63.1 percent of commercially insured patients received pain-related outpatient specialist care, whereas only 17.4 percent of Medicaid-insured patients did. And we know that timely and effective outpatient care can prevent costly emergency department visits. The use of pharmacologic options also differed between the two groups. While 65.6 percent of patients with commercial insurance filled at least one prescription for pain medication, 81.6 percent of Medicaid patients did the same.

According to the researchers, based on the study’s findings, commercially insured patients more often received treatments like physical and occupational therapy, noninvasive neurostimulation, and chiropractic care for chronic pain, whereas Medicaid-insured patients more often received medications. This suggests that type of health insurance is linked to differential access to the full range of evidence-based treatment options for chronic pain. The researchers indicate that this new insight provides opportunities to address inequities by aligning health insurance coverage and reimbursement policies with current practice guidelines, which could help to improve access to timely and effective pain care for all patients.