Papers of the Week

Analyses of healthcare data can reveal utilization of treatment options that comprise a multidisciplinary approach to chronic pain management. This retrospective cohort study aimed to characterize treatments among commercially vs. Medicaid-insured adults with incident episodes of chronic pain. We used MarketScan® data to identify patients with diagnoses for conditions associated with chronic pain, assess procedure codes that align with broad categories of treatment options, and compare receipt of treatments by insurance type. Among enrollees aged ≥18 years, 4,254,818 adults with commercial insurance and 583,369 with Medicaid met continuous enrollment criteria and had no chronic pain episodes in 2017. Among patients with incident chronic pain episodes during 2018-2020, we determined the proportions receiving different categories of treatment options during the year following diagnosis. Cohen’s h determined meaningful differences by insurance. Study cohorts included 1,095,358 commercial (mean [SD] age, 47.3 [13.3] years; 54.3% women) and 176,607 Medicaid adults (38.1 [12.7] years; 70.6% women) with incident chronic pain episodes during 2018-2020. More commercial than Medicaid patients received restorative therapies such as physical therapy (38.6% vs. 19.2%), complementary or integrative care such as chiropractic treatment (31.1% vs.9.0%), and two or more different types of nonmedication treatment procedures (34.1% vs.16.3%). Median days to treatments were shorter for commercial patients. Disparities in the provision, patterns and timing of treatments by insurance suggest differential access to the full range of treatment options early during the course of care and identify opportunities to align coverage and reimbursement policies with current practice guidelines. PERSPECTIVE: This analysis of medical claims for patients with incident chronic pain episodes found disparities in the provision, patterns and timing of treatments by insurance type. These results suggest differential access to evidence-based treatment options early during care and identify opportunities to align coverage and reimbursement policies with current practice guidelines.