Long-term analgesic use after neuroma and upper limb nerve injury: patterns in Sweden
Emma Dahlin, Raquel Perez, Malin Zimmerman, Juan Merlo, Erika Nyman, Lars B. DahlinAbstract
Objectives:
To examine demographic and socioeconomic differences in diagnosis and treatment of neuroma and nerve injury, assess risk of long-term use of centrally acting analgesics (CA-analgesics) compared with the general population, and describe how long-term use is distributed among individuals by demographic, socioeconomic, and treatment characteristics.
Methods:
In linked Swedish national registers (5,625,751 individuals, 25–80 years, residing 2010), incident cases of nonsurgically or surgically treated neuromas (n = 608‚ n = 189, respectively) or nerve injuries (n = 3,719, n = 2,122, respectively) were identified (no clinical data available) 2011 to 2014 and long-term CA-analgesic use was defined (prescription coverage ≥60% of days during 1 year; 60-day washout period after surgery). Multinomial and binary logistic regression models were used to estimate relative risks, adjusted for sex, age, income level, country of birth, and cohabiting. Absolute risks and absolute risk differences were calculated.
Results:
Neuroma or nerve injury cases were identified with variation in diagnosis and treatment by demographic and socioeconomic factors; women more likely to undergo neuroma surgery; men and younger individuals predominated among nerve injuries. All diagnostic treatment groups had markedly increased risks of long-term CA-analgesic use compared with the general population (adjusted relative risk range 3.5–6.0). Absolute risks among individuals exceeded 10% in socioeconomically disadvantaged subgroups (approximately 0.5% in the general population). Differences in long-term CA-analgesic use between nonsurgically and surgically treated individuals were modest.
Conclusions:
Neuroma and nerve injuries are associated with a substantial risk of long-term CA-analgesic use. Socioeconomic disadvantage strongly influences risk, whereas surgical treatment does not consistently reduce long-term medication use.