Individuals with epilepsy had insurance claims for opioid prescriptions and diagnoses of painful conditions that were substantially more common than in a control group of nonepileptic patients, according to a database study reported here.

Among 10,271 health plan members with a diagnosis of epilepsy in 2012, 26% had received an opioid prescription versus 18% of 20,542 members of the same plans matched for gender, age range, and insurance type (P<0.001), said Andrew Wilner, MD, of Angels Neurological Centers in Abington, Mass.

He also reported that the epilepsy patients had significantly greater rates of each of 16 pain-related conditions analyzed; overall, records of 51% of the epilepsy patients included diagnoses of at least one of these conditions compared with 39% of controls (P<0.05).

Wilner presented the findings during a poster session at the American Epilepsy Society annual meeting here.

He said the study design didn’t permit firm conclusions about the potential links between pain syndromes, opioid use, and seizure disorders. But the findings may reflect increased likelihood of pain-related comorbidities that may accompany epilepsy, he said.

“Epilepsy is not [itself] a painful condition,” Wilner noted, but seizures can trigger falls and resulting injuries. He said previous studies had found fracture rates in epilepsy patients that were double those seen in otherwise similar individuals.

He conducted the study with researchers from the Accordant Health Services unit of CVS Caremark, which funded the analysis. The group used claims data in 2012 from members of nine geographically diverse health plans contracting with Accordant for epilepsy care management. More than 3.6 million people were served by these plans, of whom 10,271 had epilepsy and were eligible for inclusion in the analysis.

The control group was drawn from the same health plans and were matched 2:1 to the epilepsy patients. Plan members with HIV, any type of malignancy, various kinds of rheumatological and genetic diseases, and organ transplant recipients were excluded from the control group, in recognition of their greater-than-average use of healthcare services.

In addition to checking for records of plan-paid opioid prescriptions, Wilner and colleagues also counted diagnoses of such pain-related conditions as headache, sciatica, sinusitis, and joint pain - a total of 16 in all.

Wilner noted that, for many of these conditions, opioids are considered ineffective, but nevertheless these are commonly prescribed in ordinary practice. He said the point of the study was to get a snapshot of how epilepsy patients are diagnosed and treated in real life.

He said the increased rates of pain diagnoses and opioid use may result from seizures or other factors directly related to epilepsy. Alternatively, patients with epilepsy may have more frequent encounters with the healthcare system (these were not counted in the study) which, in turn, could make diagnoses of other conditions more likely, Wilner suggested.

But the bottom line, he said, was that the relatively high frequency of opioid use among the epilepsy patients deserves more research in order to identify the reasons and to determine the extent to which it is or is not appropriate.

The study was funded by Accordant Health Services and several co-authors are employees.

Wilner disclosed no relevant relationships with industry.

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^{Primary source: American Epilepsy Society}
Source reference: Wilner A, et al “Analgesic opioid use in a health-insured epilepsy population during 2012” AES 2014; Abstract 1.270.