Narcotic Use in Endometriosis: A Nationwide Case-Control Study [6F]

INTRODUCTION: Endometriosis affects up to 10% of reproductive-age women and is highly co-morbid with other chronic pain conditions. Clinical suspicion is high that narcotics may be used as a mainstay of treatment for many women with endometriosis or chronic pelvic pain. Very few data are available regarding rates of narcotic use in this population. METHODS: Data were obtained from a commercial insurance claims database from employee-sponsored health plans. 706,863 patients with endometriosis/chronic pelvic pain were identified as cases. 706,863 patients without endometriosis/CPP were identified as age- and state-matched controls. Rates of narcotic use were compared in the year prior to diagnosis and the two years subsequent to diagnosis. Use subsequent to diagnosis was further analyzed by stratification by use prior to diagnosis. RESULTS: Narcotic use was higher prior to diagnosis (31.3 vs 21.3%), subsequent to diagnosis (56.3 vs 34.5%), and at higher morphine-equivalent dosages in cases vs. controls. Patient with narcotic use prior to diagnosis were more prone to use after diagnosis (74.2 vs 57.1%). All p-values <0.001. CONCLUSION: In patients with endometriosis or chronic pelvic pain, the rates of narcotic use are high both before and after diagnosis. Rates increase substantially following diagnosis. Narcotics are associated with decreased functional status and quality of life. Alternative therapies should be exhausted prior to use of narcotics as a primary mode of analgesia in these patients.