Polypharmacy, pain-related disability, and treatment fragmentation among U.S. adults without clinician advice to limit alcohol or tobacco use: A cross-sectional analysis of the 2022 Medical Expenditure Panel Survey

Pain-related disability often co-occurs with complex care patterns and high medication burden. Fragmented ambulatory care and polypharmacy may heighten adverse outcomes even among adults without clinician-identified alcohol or tobacco concerns. Using a cross-sectional analysis of the 2022 Medical Expenditure Panel Survey, we estimated the prevalence of ambulatory treatment fragmentation and polypharmacy among US adults with moderate-to-severe pain who had not received clinician advice to limit alcohol or tobacco use, and assessed their associations with emergency and inpatient utilization. The analytic sample included 1547 adults reporting moderate-to-severe pain interference with work. Treatment fragmentation was defined as seeing ≥5 unique provider specialties, and polypharmacy as filling ≥5 unique prescription medications in 2022. Outcomes were the number of emergency department (ED) visits and inpatient discharges. Survey-weighted ordinal logistic regression was used to estimate adjusted associations. High treatment fragmentation and polypharmacy occurred in 27.7% and 61.5% of adults with pain, respectively. The most common specialties were general practice (39.5%) and nursing (35.8%), and the most filled medications were atorvastatin (23.9%), metoprolol (15.5%), and gabapentin (15.4%). Each additional 5 specialties seen was associated with more ED visits (adjusted odds ratio [aOR] = 1.59; 95% confidence interval [CI], 1.15-2.21) but was not significantly associated with inpatient discharges (aOR = 1.38; 95% CI, 0.92-2.05). Each additional 5 unique medications filled was associated with more ED visits (aOR = 1.47; 95% CI, 1.24-1.74) and inpatient discharges (aOR = 1.44; 95% CI, 1.19-1.74). These findings suggest that care fragmentation and polypharmacy are common among adults with pain who have not received clinician advice to limit alcohol or tobacco use and are independently associated with greater acute-care utilization. Strengthening care coordination and medication oversight may help mitigate these risks.