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Baumann-Larsen M, Storheim K, Stangeland H, Zwart JA, Wentzel-Larsen T, Skurtveit S, Dyb G, Stensland SØ. Childhood trauma and the use of opioids and other prescription analgesics in adolescence and young adulthood: The HUNT Study. Pain 2024; 165:1317-1326. [PMID: 38126936 PMCID: PMC11090031 DOI: 10.1097/j.pain.0000000000003131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/04/2023] [Accepted: 11/07/2023] [Indexed: 12/23/2023]
Abstract
ABSTRACT Opioid and nonopioid analgesics are commonly prescribed to young people to alleviate pain. Even short-term prescriptions increase the risk of persistent use and future misuse of potent analgesics, such as opioids. Childhood trauma exposure has been found to be related to pain conditions and to using more prescription analgesics. This large, prospective cohort study aimed to investigate the association of a broad range of childhood trauma exposures with prescription rates for opioid and nonopioid analgesics in adolescence and young adulthood. Self-reported data on childhood trauma exposures from adolescents (aged 13-19 years) who participated in the Young-HUNT3 Study (2006-2008, n = 8199) were linked to data from the Norwegian Prescription Database (NorPD, 2004-2021). We found that exposure to childhood trauma was consistently associated with higher prescription rates for opioids throughout adolescence and young adulthood. The highest incidence rate ratio (IRR) in adolescence was observed for sexual abuse (IRR 1.63, confidence interval [CI] 1.19-2.23). In young adulthood, the highest IRR was observed for physical violence (2.66, CI 2.27-3.12). The same overall pattern was observed for nonopioid analgesics. The more frequent prescriptions of opioid and nonopioid analgesics to participants exposed to childhood trauma suggests a higher symptom load of pain causing them to seek professional help with pain relief. Receiving potent analgesics is not without risk, and the likelihood of misuse may be elevated among trauma-exposed individuals. A trauma-informed approach to pain could be vital for guiding clinicians to the most effective and least harmful treatment for each patient.
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Affiliation(s)
- Monica Baumann-Larsen
- Division of Clinical Neuroscience, Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kjersti Storheim
- Division of Clinical Neuroscience, Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Helle Stangeland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - John-Anker Zwart
- Division of Clinical Neuroscience, Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Tore Wentzel-Larsen
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Svetlana Skurtveit
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Grete Dyb
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Synne Øien Stensland
- Division of Clinical Neuroscience, Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
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Chen TC, Lin CP, Wang TC, Ashcroft DM, Chan KA, Chen LC. Longitudinal Trajectory of Opioid Prescribing and its Associated Serious Adverse Events: A Population-Wide Cohort Study in Taiwan. Clin Pharmacol Ther 2023; 114:1358-1365. [PMID: 37746873 DOI: 10.1002/cpt.3058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/08/2023] [Indexed: 09/26/2023]
Abstract
Chronic opioid prescribing (COP) for noncancer pain is highly restricted in Taiwan, but tramadol is not listed in the regulation on chronic prescribing. This study investigated the trajectories of COP in noncancer pain when considering tramadol in Taiwan and identified the risk of serious adverse events. This population-wide longitudinal cohort study used the Taiwan National Health Insurance claims records from 2001 to 2016. Adults prescribed opioids (including tramadol) and without cancer were selected. Patients who received COP (opioid supply days for 28 days or continuous opioid supply for 14 days) in the first patient quarter were included, and serious adverse events were identified. Group-based trajectory models were applied to identify patients with a similar trajectory of quarterly COP. The Cox proportional hazard model was applied to assess the association between adverse events and patients' trajectories. Of the 2,360,358 noncancer opioid users, 476,934 (20.2%) received COP in the first quarter. Four groups of COP trajectory were identified, and 59,310 (12.8%) patients received COP quarterly over 2 years. Patients categorized into the trajectory of long-term COP had a significantly higher crude incidence rate of cardiovascular death, seizure, and hypoglycemia. Still, there is no newly developed opioid use disorder. There was a substantial underestimate in COP in Taiwan when tramadol was not considered. Notably, 10% of them could receive COP for over 2 years. The result raises concern about unmet pain management needs and the limited accessibility of alternative treatments for noncancer pain.
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Affiliation(s)
- Teng-Chou Chen
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, University of Manchester, Manchester, UK
- Department of Pharmacy, School of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Peng Lin
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Anesthesiology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ting-Chun Wang
- Health Data Research Center, National Taiwan University, Taipei, Taiwan
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - K Arnold Chan
- Health Data Research Center, National Taiwan University, Taipei, Taiwan
| | - Li-Chia Chen
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, University of Manchester, Manchester, UK
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Eriksen AMA, Melhus M, Schei B, Skurtveit S, Broderstad AR. Opioid prescriptions among Sami and non-Sami with chronic pain: The SAMINOR 2 Questionnaire Survey and the Norwegian Prescription Database. Int J Circumpolar Health 2023; 82:2241202. [PMID: 37506380 PMCID: PMC10392314 DOI: 10.1080/22423982.2023.2241202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023] Open
Abstract
This study is the first to investigate the prevalence of filled opioid prescriptions among indigenous Sami people with self-reported chronic musculoskeletal pain (CMSP) and compare it with that of non-Sami living in the same area. Baseline data from the SAMINOR 2 Questionnaire Survey (2012) was linked prospectively to the Norwegian Prescription Database. Information on filled opioid prescriptions during 2012-2019 was collected for 4767 persons who reported CMSP in SAMINOR 2. Gender-stratified chi-square tests, two-sample t-tests, Kruskal - Wallis tests, and multinomial logistic regression was applied. Two out of three CMSP respondents received no or only one prescription of opioids during 2012-2019. In each year, 80% of women received no opioids, 7-10% received one prescription of ≤ 180 defined daily doses (DDD), 8-9% received in total ≤ 180 DDD in two or more prescriptions, and 2-3% received > 180 DDD of opioids. Among men, 81-83% received no opioids, 8-11% received one prescription with ≤ 180 DDD, 5-9% received ≤ 180 DDD in two or more prescriptions, and 1-2% received > 180 DDD of opioids in a single year. There were no overall ethnic differences, which indicates a similar prescription policy for opioids for Sami and non-Sami with CMSP.
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Affiliation(s)
- Astrid M A Eriksen
- Centre for Sami Health Research, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Marita Melhus
- Centre for Sami Health Research, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Berit Schei
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Norwegian University of Science and Technology (NTNU), Department of Obstetrics and Gynecology, Trondheim, Norway
| | - Svetlana Skurtveit
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ann-Ragnhild Broderstad
- Centre for Sami Health Research, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
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Chen TC, Wettermark B, Steinke D, Caughey GE, Tadrous M, Wirtz VJ, Chen LC. Feasibility and validity of using healthcare databases to conduct cross-national comparative studies of opioid use, its determinants and consequences. Pharmacoepidemiol Drug Saf 2023; 32:1021-1031. [PMID: 36942801 DOI: 10.1002/pds.5618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 02/28/2023] [Accepted: 03/16/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE A cross-national comparative (CNC) study about opioid utilization would allow the identification of strategies to improve pain management and mitigate risk. However, little is known about the accessibility and validity of information in healthcare databases internationally. This study aimed to identify the feasibility of using healthcare databases to conduct a CNC study of opioid utilization and its associated consequences. METHODS A cross-sectional survey was launched in March 2018, including experts interested in CNC studies comparing opioid utilization by purposeful sampling. An electronic survey was used to collect database characteristics, medicine information, and linkage information of each aggregate-level dataset (AD) and individual patient-level dataset (IPD). RESULTS Overall, participants from 21 geographical regions reported 18 ADs and 19 IPDs. Information on dispensed medications is available from 17 ADs and 17 IPDs. Of the 16 ADs that include primary care settings, only 9 ADs can obtain information from secondary care settings. Fourteen IPDs included patients' characteristics or could be retrieved from linkage databases. Although most ADs are publicly accessible (n = 13), only five IPDs can be accessed without extra cost. CONCLUSION Most ADs could be used to report opioid utilization in a primary care setting. IPDs with linkage databases should be applied to identify potential determinants, clinical outcomes, and policy impact. Data access restrictions and governance policies across jurisdictions can be challenging for timely analysis and require further collaboration.
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Affiliation(s)
- Teng-Chou Chen
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Björn Wettermark
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
- Pharmacy Center, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Douglas Steinke
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Gillian E Caughey
- Registry of Senior Australians, South Australian Health and Medical Research Institute and Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Mina Tadrous
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Veronika J Wirtz
- Department of Global Health, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Li-Chia Chen
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Hansen JL, Heilig M, Kalso E, Stubhaug A, Knutsson D, Sandin P, Dorling P, Beck C, Grip ET, Blakeman KH, Arendt-Nielsen L. Problematic opioid use among osteoarthritis patients with chronic post-operative pain after joint replacement: analyses from the BISCUITS study. Scand J Pain 2023; 23:353-363. [PMID: 36799711 DOI: 10.1515/sjpain-2022-0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/31/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVES Opioids are commonly used to manage pain, despite an increased risk of adverse events and complications when used against recommendations. This register study uses data of osteoarthritis (OA) patients with joint replacement surgery to identify and characterize problematic opioid use (POU) prescription patterns. METHODS The study population included adult patients diagnosed with OA in specialty care undergoing joint replacement surgery in Denmark, Finland, Norway, and Sweden during 1 January 2011 to 31 December 2014. Those with cancer or OA within three years before the first eligible OA diagnosis were excluded. Patients were allocated into six POU cohorts based on dose escalation, frequency, and dosing of prescription opioids post-surgery (definitions were based on guidelines, previous literature, and clinical experience), and matched on age and sex to patients with opioid use, but not in any of the six cohorts. Data on demographics, non-OA pain diagnoses, cardiovascular diseases, psychiatric disorders, and clinical characteristics were used to study patient characteristics and predictors of POU. RESULTS 13.7% of patients with OA and a hip/knee joint replacement were classified as problematic users and they had more comorbidities and higher pre-surgery doses of opioids than matches. Patients dispensing high doses of opioids pre-surgery dispensed increased doses post-surgery, a pattern not seen among patients prescribed lower doses pre-surgery. Being dispensed 1-4,500 oral morphine equivalents in the year pre-surgery or having a non-OA pain diagnosis was associated with post-surgery POU (OR: 1.44-1.50, and 1.11-1.20, respectively). CONCLUSIONS Based on the discovered POU predictors, the study suggests that prescribers should carefully assess pain management strategies for patients with a history of comorbidities and pre-operative, long-term opioid use. Healthcare units should adopt risk assessment tools and ensure that these patients are followed up closely. The data also demonstrate potential areas for further exploration in improving patient outcomes and trajectories.
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Affiliation(s)
- Johan Liseth Hansen
- Quantify Research, Stockholm, Sweden
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Markus Heilig
- Center for Social and Affective Neuroscience (CSAN), Department of Biomedical and Clinical Sciences (BKV), Linköping University, Linköping, Sweden
| | - Eija Kalso
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Audun Stubhaug
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | | | | | | | - Emilie Toresson Grip
- Quantify Research, Stockholm, Sweden
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | | | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
- Department of Medical Gastroenterology (Mech-Sense), Aalborg University Hospital, Aalborg, Denmark
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Chen TC, Kurdi A, Su TL, Chen LC. Regional variation in longitudinal trajectories of primary care opioids prescribing across Health Boards in Scotland: a population-based study. Expert Rev Clin Pharmacol 2022; 15:897-905. [PMID: 35848072 DOI: 10.1080/17512433.2022.2102972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND This study aims to describe the longitudinal trajectory of opioid prescribing at the practice level and assess associated factors, including Health Boards and socioeconomic status. RESEARCH DESIGN AND METHODS This drug utilization research used practice-level dispensing data from 2016 to 2018. Practice-level prescription opioids dispensed were quantified by the defined daily doses (DDDs) per 1000 registrants. Group-based trajectory models were used to identify groups of practices with similar trajectories based on the difference in monthly opioid utilization. Characteristics of registrants were associated with the trajectory by a conditional logistic regression and the prescription opioids dispensed by a random-effect regression model. RESULTS Of the 798 practices, 29.5% increased opioid prescription by an additional 100 DDDs/1000 registrants/month during 2017 and 2018. Practice in southwest Scotland tended to be categorized into the group with increasing opioid utilization. Deprived socioeconomic status was associated with increasing opioid utilization (odds ratio: 2.2; 95% confidence interval: 1.5, 3.2) or higher annual opioid utilization (coefficient: 358.2; 95% confidence interval: 327.6, 388.8). CONCLUSIONS Increasing opioid utilization over time was related to deprived socioeconomic status associated with chronic pain conditions and inequality in pain services. Further strategies to balance inequality are needed, which needs further investigation.
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Affiliation(s)
- Teng-Chou Chen
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Science, University of Strathclyde, Glasgow, UK.,Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq.,Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Ting-Li Su
- Division of Dentistry, School of Medical Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Li-Chia Chen
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Persistent Use of Prescription Opioids Following Lumbar Spine Surgery: Observational Study with Prospectively Collected Data From Two Norwegian Nationwide Registries. Spine (Phila Pa 1976) 2022; 47:607-614. [PMID: 34798646 DOI: 10.1097/brs.0000000000004275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective pharmacoepidemiological study. OBJECTIVE To investigate the use of prescription opioids 2 years following degenerative lumbar spine surgery. SUMMARY OF BACKGROUND DATA There are limited data providing details to evaluate patterns of opioid use. The number of patients is often limited and data on opioid use following some of the most common surgical procedures are lacking. METHODS Data from the Norwegian Registry for Spine Surgery and the Norwegian Prescription Database were linked on an individual level. The primary outcome measure was persistent opioid use the second year after surgery. Functional disabilitywas measured with the Oswestry disability index (ODI). Study participants were operated between 2007 and 2017. RESULTS Among 32,886 study participants, 2754 (8.4%) met criteria for persistent opioid use the second year after surgery. Among persistent opioid users in the second year after surgery, 64% met the criteria for persistent opioid use the year preceding surgery. Persistent opioid use the year preceding surgery (odds ratio [OR] 31.10, 95% confidence interval [CI] 26.9-36.0, P = 0.001), use of high doses of benzodiazepines (OR 1.62, 95% CI 1.30-2.04, P = 0.001), and use of high doses of z-hypnotics (OR 1.90, 95% CI 1.58-2.22, P = 0.001) the year before surgery were associated with increased risk of persistent opioid use the second year after surgery. A higher ODI score at 1 year was observed in persistent opioid users compared with non-persistent users (41.5 vs. 18.8 points) and there was a significant difference in ODI change (-13.7 points). Patients with persistent opioid use in the year preceding surgery were less likely to achieve a minimal clinically important ODI change at 1 year compared with non-persistent users (37.7% vs. 52.6%, P = 0.001). CONCLUSION Patients with or at risk of developing persistent opioid should be identified and provided counseling and support to taper off opioid treatment.Level of Evidence: 2.
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Niznik J, Ferreri SP, Armistead L, Urick B, Vest MH, Zhao L, Hughes T, McBride JM, Busby-Whitehead J. A deprescribing medication program to evaluate falls in older adults: methods for a randomized pragmatic clinical trial. Trials 2022; 23:256. [PMID: 35379307 PMCID: PMC8981935 DOI: 10.1186/s13063-022-06164-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background Opioids and benzodiazepines (BZDs) are some of the most commonly prescribed medications that contribute to falls in older adults. These medications are challenging to appropriately prescribe and monitor, with little guidance on safe prescribing of these medications for older patients. Only a handful of small studies have evaluated whether reducing opioid and BZD use through deprescribing has a positive impact on outcomes. Leveraging the strengths of a large health system, we evaluated the impact of a targeted consultant pharmacist intervention to deprescribe opioids and BZDs for older adults seen in primary care practices in North Carolina. Methods We developed a toolkit and process for deprescribing opioids and BZDs in older adults based on a literature review and guidance from an interprofessional team of pharmacists, geriatricians, and investigators. A total of fifteen primary care practices have been randomized to receive the targeted consultant pharmacist service (n = 8) or usual care (n = 7). The intervention consists of several components: (1) weekly automated reports to identify chronic users of opioids and BZDs, (2) clinical pharmacist medication review, and (3) recommendations for deprescribing and/or alternate therapies routed to prescribers through the electronic health record. We will collect data for all patients presenting one of the primary care clinics who meet the criteria for chronic use of opioids and/or BZDs, based on their prescription order history. We will use the year prior to evaluate baseline medication exposures using morphine milligram equivalents (MMEs) and diazepam milligram equivalents (DMEs). In the year following the intervention, we will evaluate changes in medication exposures and medication discontinuations between control and intervention clinics. Incident falls will be evaluated as a secondary outcome. To date, the study has enrolled 914 chronic opioid users and 1048 chronic BZD users. We anticipate that we will have 80% power to detect a 30% reduction in MMEs or DMEs. Discussion This clinic randomized pragmatic trial will contribute valuable evidence regarding the impact of pharmacist interventions to reduce falls in older adults through deprescribing of opioids and BZDs in primary care settings. Trial registration Clinicaltrials.govNCT04272671. Registered on February 17, 2020 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06164-5.
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Hamina A, Hjellvik V, Handal M, Odsbu I, Clausen T, Skurtveit S. Describing long-term opioid use utilizing Nordic Prescription Registers - A Norwegian example. Basic Clin Pharmacol Toxicol 2022; 130:481-491. [PMID: 35037407 DOI: 10.1111/bcpt.13706] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/13/2021] [Accepted: 01/11/2022] [Indexed: 11/28/2022]
Abstract
Previous studies have defined long-term opioid use in varying ways, decreasing comparability, reproducibility, and clinical applicability of the research. Based on recommendations from recent systematic reviews, we aimed to develop a methodology to estimate the prevalence of use persisting more than three months utilizing one of the Nordic prescription registers. We used the Norwegian Prescription Register (NorPD) to extract data on all opioid dispensations between 1 January 2004 and 31 October 2019. New users of opioids (washout 365 days) were defined as long-term users if they fulfilled two criteria: 1) they had ≥2 dispensations of opioids, 91-180 days apart; 2) days 0-90 included ≥90 dispensed administration units (e.g., tablets) of opioids. Overall, there were 2,543,224 new users of opioids during the study period. Of these, 354,666 (13.9%) fulfilled the criteria for long-term opioid use at least once. Compared with those who did not fulfill the criteria (short-term users), long-term users were older, more likely women, and used tramadol, oxycodone, and buprenorphine more frequently as their first opioid. In conclusion, we found that 1/7 of opioid users continued use longer than 3 months. Future outcome research should identify the clinically most important dose requirements for long-term opioid use criteria.
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Affiliation(s)
- A Hamina
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - V Hjellvik
- Department of Chronic Diseases and Ageing, Division of Mental and Physical Health, the Norwegian Institute of Public Health, Oslo, Norway
| | - M Handal
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Mental Disorders, Division of Mental and Physical Health, the Norwegian Institute of Public Health, Oslo, Norway
| | - I Odsbu
- Department of Mental Disorders, Division of Mental and Physical Health, the Norwegian Institute of Public Health, Oslo, Norway
| | - T Clausen
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - S Skurtveit
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Mental Disorders, Division of Mental and Physical Health, the Norwegian Institute of Public Health, Oslo, Norway
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Optimizing drug selection from a prescription trajectory of one patient. NPJ Digit Med 2021; 4:150. [PMID: 34671068 PMCID: PMC8528868 DOI: 10.1038/s41746-021-00522-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/27/2021] [Indexed: 12/25/2022] Open
Abstract
It is unknown how sequential drug patterns convey information on a patient's health status and treatment guidelines rarely account for this. Drug-agnostic longitudinal analyses of prescription trajectories in a population-wide setting are needed. In this cohort study, we used 24 years of data (1.1 billion prescriptions) from the Danish prescription registry to model the risk of sequentially redeeming a drug after another. Drug pairs were used to build multistep longitudinal prescription trajectories. These were subsequently used to stratify patients and calculate survival hazard ratios between the stratified groups. The similarity between prescription histories was used to determine individuals' best treatment option. Over the course of 122 million person-years of observation, we identified 9 million common prescription trajectories and demonstrated their predictive power using hypertension as a case. Among patients treated with agents acting on the renin-angiotensin system we identified four groups: patients prescribed angiotensin converting enzyme (ACE) inhibitor without change, angiotensin receptor blockers (ARBs) without change, ACE with posterior change to ARB, and ARB posteriorly changed to ACE. In an adjusted time-to-event analysis, individuals treated with ACE compared to those treated with ARB had lower survival probability (hazard ratio, 0.73 [95% CI, 0.64-0.82]; P < 1 × 10-16). Replication in UK Biobank data showed the same trends. Prescription trajectories can provide novel insights into how individuals' drug use change over time, identify suboptimal or futile prescriptions and suggest initial treatments different from first line therapies. Observations of this kind may also be important when updating treatment guidelines.
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Hussain SM, Wang Y, Peeters G, Wluka AE, Mishra GD, Teede H, Urquhart D, Brown WJ, Cicuttini FM. Association between clusters of back and joint pain with opioid use in middle-aged community-based women: a prospective cohort study. BMC Musculoskelet Disord 2021; 22:863. [PMID: 34627214 PMCID: PMC8502269 DOI: 10.1186/s12891-021-04741-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/15/2021] [Indexed: 12/12/2022] Open
Abstract
Background To determine the relationship between clusters of back pain and joint pain and prescription opioid dispensing. Methods Of 11,221 middle-aged participants from the Australian Longitudinal Study of Women’s Health, clusters of back pain and joint pain from 2001 to 2013 were identified using group-based trajectory modelling. Prescription opioid dispensing from 2003 to 2015 was identified by linking the cohort to Pharmaceutical Benefit Scheme dispensing data. Multinomial logistic regression was used to examine the association between back pain and joint pain clusters and dispensing of prescription opioids. The proportion of opioids dispensed in the population attributable to back and join pain was calculated. Results Over 12 years, 68.5 and 72.0% women reported frequent or persistent back pain and joint pain, respectively. There were three clusters (‘none or infrequent’, ‘frequent’ and ‘persistent’) for both back pain and joint pain. Those in the persistent back pain cluster had a 6.33 (95%CI 4.38-9.16) times increased risk of having > 50 opioid prescriptions and those in persistent joint pain cluster had a 6.19 (95%CI 4.18-9.16) times increased risk of having > 50 opioid prescriptions. Frequent and persistent back and joint pain clusters together explained 41.7% (95%CI 34.9-47.8%) of prescription opioid dispensing. Women in the frequent and persistent back pain and joint pain clusters were less educated and reported more depression and physical inactivity. Conclusion Back pain and joint pain are major contributors to opioid prescription dispensing in community-based middle-aged women. Additional approaches to reduce opioid use, targeted at those with frequent and persistent back pain and joint pain, will be important in order to reduce the use of opioids and their consequent harm in this population. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04741-4.
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Affiliation(s)
- Sultana Monira Hussain
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Yuanyuan Wang
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Geeske Peeters
- Department of Geriatric Medicine, Radboud Institute of Health Science, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Anita E Wluka
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Gita D Mishra
- Institute for Social Science Research, the University of Queensland, St Lucia, Australia
| | - Helena Teede
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Donna Urquhart
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Wendy J Brown
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, the University of Queensland, St Lucia, Australia
| | - Flavia M Cicuttini
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
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12
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Alderson SL, Farragher TM, Willis TA, Carder P, Johnson S, Foy R. The effects of an evidence- and theory-informed feedback intervention on opioid prescribing for non-cancer pain in primary care: A controlled interrupted time series analysis. PLoS Med 2021; 18:e1003796. [PMID: 34606504 PMCID: PMC8489725 DOI: 10.1371/journal.pmed.1003796] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 09/03/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The rise in opioid prescribing in primary care represents a significant international public health challenge, associated with increased psychosocial problems, hospitalisations, and mortality. We evaluated the effects of a comparative feedback intervention with persuasive messaging and action planning on opioid prescribing in primary care. METHODS AND FINDINGS A quasi-experimental controlled interrupted time series analysis used anonymised, aggregated practice data from electronic health records and prescribing data from publicly available sources. The study included 316 intervention and 130 control primary care practices in the Yorkshire and Humber region, UK, serving 2.2 million and 1 million residents, respectively. We observed the number of adult patients prescribed opioid medication by practice between July 2013 and December 2017. We excluded adults with coded cancer or drug dependency. The intervention, the Campaign to Reduce Opioid Prescribing (CROP), entailed bimonthly, comparative, and practice-individualised feedback reports to practices, with persuasive messaging and suggested actions over 1 year. Outcomes comprised the number of adults per 1,000 adults per month prescribed any opioid (main outcome), prescribed strong opioids, prescribed opioids in high-risk groups, prescribed other analgesics, and referred to musculoskeletal services. The number of adults prescribed any opioid rose pre-intervention in both intervention and control practices, by 0.18 (95% CI 0.11, 0.25) and 0.36 (95% CI 0.27, 0.46) per 1,000 adults per month, respectively. During the intervention period, prescribing per 1,000 adults fell in intervention practices (change -0.11; 95% CI -0.30, -0.08) and continued rising in control practices (change 0.54; 95% CI 0.29, 0.78), with a difference of -0.65 per 1,000 patients (95% CI -0.96, -0.34), corresponding to 15,000 fewer patients prescribed opioids. These trends continued post-intervention, although at slower rates. Prescribing of strong opioids, total opioid prescriptions, and prescribing in high-risk patient groups also generally fell. Prescribing of other analgesics fell whilst musculoskeletal referrals did not rise. Effects were attenuated after feedback ceased. Study limitations include being limited to 1 region in the UK, possible coding errors in routine data, being unable to fully account for concurrent interventions, and uncertainties over how general practices actually used the feedback reports and whether reductions in prescribing were always clinically appropriate. CONCLUSIONS Repeated comparative feedback offers a promising and relatively efficient population-level approach to reduce opioid prescribing in primary care, including prescribing of strong opioids and prescribing in high-risk patient groups. Such feedback may also prompt clinicians to reconsider prescribing other medicines associated with chronic pain, without causing a rise in referrals to musculoskeletal clinics. Feedback may need to be sustained for maximum effect.
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Affiliation(s)
- Sarah L. Alderson
- Leeds Institute of Health Science, University of Leeds, Leeds, United Kingdom
- * E-mail:
| | - Tracey M. Farragher
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom
| | - Thomas A. Willis
- Leeds Institute of Health Science, University of Leeds, Leeds, United Kingdom
| | - Paul Carder
- West Yorkshire Research and Development, National Health Service Bradford Districts Clinical Commissioning Group, Bradford, United Kingdom
| | - Stella Johnson
- West Yorkshire Research and Development, National Health Service Bradford Districts Clinical Commissioning Group, Bradford, United Kingdom
| | - Robbie Foy
- Leeds Institute of Health Science, University of Leeds, Leeds, United Kingdom
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13
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Chen TC, Knaggs RD, Chen LC. Association between opioid-related deaths and persistent opioid prescribing in primary care in England: a nested case-control study. Br J Clin Pharmacol 2021; 88:798-809. [PMID: 34371521 DOI: 10.1111/bcp.15028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 07/02/2021] [Accepted: 07/28/2021] [Indexed: 11/26/2022] Open
Abstract
AIM This study aimed to evaluate the association between opioid-related deaths and persistent opioid utilisation in the United Kingdom (UK). METHODS This nested case-control study used the UK Clinical Practice Research Datalink, linking the Office for National Statistics death registration. Adult opioid users with recorded opioid-related death between 2000 and 2015 were included and matched to four opioid users (controls) based on a disease risk score. Persistent opioid utilisation (opioid prescriptions ≥3 quarters/year and oral morphine equivalent dose ≥4500 mg/year) and psychotropic prescriptions were identified annually during the three patient-years before the date of opioid-related death. Conditional logistic regression was used to assess the association between persistent opioid utilisation and opioid-related death, and the results were reported as adjusted odds ratios (aOR) and 95% confidence intervals (95%CI). RESULTS Of the 902,149 opioid users, 230 opioid-related deaths (cases) and 920 controls were identified. Persistent opioid utilisation was significantly associated with an increased risk of opioid-related deaths (aOR: 1.9; 95%CI: 1.2, 2.9) when persistent opioid utilisation was defined by both annual dose and number of quarters. Concurrent prescription of opioids and tricyclic antidepressants (aOR: 2.0; 95%CI: 1.2, 3.5) or higher dose of benzodiazepine (aOR: 6.5; 95%CI: 4.0, 10.4) or gabapentinoids (aOR: 6.2; 95%CI: 2.9, 13.5) were associated with opioid-related death. CONCLUSION Persistent opioid prescribing and concurrent prescribing of psychotropics were associated with a higher risk of opioid-related death and should be avoided in clinical practice. An evidence-based indicator to monitor the safety of prescribed opioids during opioid de-prescribing is needed.
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Affiliation(s)
- Teng-Chou Chen
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre
| | - Roger David Knaggs
- Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham.,Primary Integrated Community Solutions.,Pain Centre Versus Arthritis, University of Nottingham
| | - Li-Chia Chen
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre
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14
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Fredheim OM, Skurtveit S, Sjøgren P, Aljabri B, Hjellvik V. Prescriptions of analgesics during chronic cancer disease trajectories: A complete national cohort study. Pharmacoepidemiol Drug Saf 2021; 30:1504-1513. [PMID: 34251721 DOI: 10.1002/pds.5329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/29/2021] [Accepted: 07/09/2021] [Indexed: 11/12/2022]
Abstract
PURPOSE Pain management principles vary considerably between chronic noncancer, acute and cancer pain. Cancer patients responding to oncological treatment may live with low tumor burden for years. Opioid treatment should reflect that the ratio between benefits and risks in these patients is different from patients with a rapidly progressive disease. Our study investigated the prescription patterns of analgesics in patients who died 6 to 9 years after cancer diagnosis. PATIENTS AND METHODS A pharmaco-epidemiological study based on the Norwegian Prescription Database and Cancer Registry of Norway. The 1-year periodic prevalence of receiving different analgesics and of persistent opioid use were analyzed. Persistent opioid use was defined as >365 Defined Daily Doses or >9000 mg Oral Morphine Equivalents during 365 days with prescriptions in all quarters of the 365 days period. Data were reported for the first 7 years for patients who lived 8-9 years after cancer diagnosis (N = 1502), while for patients who lived 6-7 years (N = 3817) data was reported for the first 5 years after diagnosis. RESULTS Compared to age- and gender adjusted general population, the 1-year periodic prevalence of opioid prescription was doubled the first year after diagnosis and remained raised with approximately 50%. The prevalence of persistent opioid use was threefold of the general population. Approximately 55% of patients with persistent opioid use 4 years after a cancer diagnosis were co-medicated with high doses of benzodiazepines and/or benzodiazepine-related hypnotics. CONCLUSION The findings of increased opioid use raise concerns regarding whether the benefits outweigh risks and side effects in this population.
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Affiliation(s)
- Olav Magnus Fredheim
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Norwegian Advisory Unit on Complex Symptom Disorders, St. Olav University Hospital, Trondheim, Norway.,Department of Palliative Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Svetlana Skurtveit
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway.,Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
| | - Per Sjøgren
- Section of Palliative Medicine, Department of Oncology, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Belal Aljabri
- Department of Palliative Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Vidar Hjellvik
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
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15
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Opioid Prescriptions in Chronic Pain Rehabilitation. A Prospective Study on the Prevalence and Association between Individual Patient Characteristics and Opioids. J Clin Med 2021; 10:jcm10102130. [PMID: 34069098 PMCID: PMC8155870 DOI: 10.3390/jcm10102130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/30/2021] [Accepted: 05/12/2021] [Indexed: 11/17/2022] Open
Abstract
While against recommendations, long-term opioid therapy (LTOT) for chronic pain is common. This study aimed to describe the prevalence of opioid prescriptions and to study the association of patient characteristics (demographics, pain characteristics, anxiety, depressive symptoms and pain coping) with future LTOT. The sample included N = 1334 chronic musculoskeletal pain patients, aged 18–65, who were assessed for Interdisciplinary Multimodal Pain Rehabilitation (IMMR) in Swedish specialist rehabilitation. Prescriptions were tracked across a two-year target period after assessment. In total, 9100 opioid prescriptions were prescribed to 55% of the sample (Mmedian = 6, IQR = 14). Prediction of LTOT was analyzed separately for those who did (24%) and did not (76%) receive IMMR. The odds of receiving opioids was similar for these subsamples, after controlling for differences in baseline characteristics. In both samples, there were significant associations between patient characteristics and future opioid prescriptions. Dysfunctional pain coping was a unique predictor of LTOT in those who received IMMR while pain intensity and depressive symptoms were unique predictors in those who did not receive IMMR. The results underscore that opioid treatment is common among patients in chronic pain rehabilitation and relates to pain and psychological factors. Understanding in detail why these factors relate to opioid prescription patterns is an important future study area as it is a prerequisite for better management and fundamental for preventing overuse.
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16
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Piwowarczyk P, Kaczmarska A, Kutnik P, Hap A, Chajec J, Myśliwiec U, Czuczwar M, Borys M. Association of Gender, Painkiller Use, and Experienced Pain with Pain-Related Fear and Anxiety among University Students According to the Fear of Pain Questionnaire-9. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084098. [PMID: 33924523 PMCID: PMC8068817 DOI: 10.3390/ijerph18084098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/02/2021] [Accepted: 04/10/2021] [Indexed: 11/30/2022]
Abstract
Anxiety and fear are determinants of acute and chronic pain. Effectively measuring fear associated with pain is critical for identifying individuals’ vulnerable to pain. This study aimed to assess fear of pain among students and evaluate factors associated with pain-related fear. We used the Fear of Pain Questionnaire-9 to measure this fear. We searched for factors associated with fear of pain: gender, size of the city where the subjects lived, subject of academic study, year of study, the greatest extent of experienced pain, frequency of painkiller use, presence of chronic or mental illness, and past hospitalization. We enrolled 717 participants. Median fear of minor pain was 5 (4–7) fear of medical pain 7 (5–9), fear of severe pain 10 (8–12), and overall fear of pain 22 (19–26). Fear of pain was associated with gender, frequency of painkiller use, and previously experienced pain intensity. We found a correlation between the greatest pain the participant can remember and fear of minor pain (r = 0.112), fear of medical pain (r = 0.116), and overall fear of pain (r = 0.133). Participants studying medicine had the lowest fear of minor pain while stomatology students had the lowest fear of medical pain. As students advanced in their studies, their fear of medical pain lowered. Addressing fear of pain according to sex of the patient, frequency of painkiller use, and greatest extent of experienced pain could ameliorate medical training and improve the quality of pain management in patients.
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Affiliation(s)
- Paweł Piwowarczyk
- II Department of Anesthesiology and Intensive Care, Medical University of Lublin, 20-081 Lublin, Poland; (P.K.); (M.C.); (M.B.)
- Correspondence:
| | - Agnieszka Kaczmarska
- Student’s Scientific Association, II Department of Anesthesiology and Intensive Care, Medical University of Lublin, 20-081 Lublin, Poland; (A.K.); (A.H.); (J.C.); (U.M.)
| | - Paweł Kutnik
- II Department of Anesthesiology and Intensive Care, Medical University of Lublin, 20-081 Lublin, Poland; (P.K.); (M.C.); (M.B.)
| | - Aleksandra Hap
- Student’s Scientific Association, II Department of Anesthesiology and Intensive Care, Medical University of Lublin, 20-081 Lublin, Poland; (A.K.); (A.H.); (J.C.); (U.M.)
| | - Joanna Chajec
- Student’s Scientific Association, II Department of Anesthesiology and Intensive Care, Medical University of Lublin, 20-081 Lublin, Poland; (A.K.); (A.H.); (J.C.); (U.M.)
| | - Urszula Myśliwiec
- Student’s Scientific Association, II Department of Anesthesiology and Intensive Care, Medical University of Lublin, 20-081 Lublin, Poland; (A.K.); (A.H.); (J.C.); (U.M.)
| | - Mirosław Czuczwar
- II Department of Anesthesiology and Intensive Care, Medical University of Lublin, 20-081 Lublin, Poland; (P.K.); (M.C.); (M.B.)
| | - Michał Borys
- II Department of Anesthesiology and Intensive Care, Medical University of Lublin, 20-081 Lublin, Poland; (P.K.); (M.C.); (M.B.)
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17
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de Oliveira Costa J, Bruno C, Baranwal N, Gisev N, Dobbins TA, Degenhardt L, Pearson SA. Variations in Long-term Opioid Therapy Definitions: A Systematic Review of Observational Studies Using Routinely Collected Data (2000-2019). Br J Clin Pharmacol 2021; 87:3706-3720. [PMID: 33629352 DOI: 10.1111/bcp.14798] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/21/2020] [Accepted: 02/17/2021] [Indexed: 12/27/2022] Open
Abstract
Routinely collected data have been increasingly used to assess long-term opioid therapy (LTOT) patterns, with very little guidance on how to measure LTOT from these data sources. We conducted a systematic review of studies published between January 2000 and July 2019 to catalogue LTOT definitions, the rationale for definitions and LTOT rates in observational research using routinely collected data in nonsurgical settings. We screened 4056 abstracts, 210 full-text manuscripts and included 128 studies, mostly from the United States (81%) and published between 2015 and 2019 (69%). We identified 78 definitions of LTOT, commonly operationalised as 90 days of use within a year (23%). Studies often used multiple criteria to derive definitions (60%), mostly based on measures of duration, such as supply days/days of use (66%), episode length (21%) or prescription fills within specified time periods (12%). Definitions were based on previous publications (63%), clinical judgment (16%) or empirical data (3%); 10% of studies applied more than one definition. LTOT definition was not provided with enough details for replication in 14 studies and 38 studies did not specify the opioids evaluated. Rates of LTOT within study populations ranged from 0.2% to 57% according to study design and definition used. We observed a substantial rise in the last 5 years in studies evaluating LTOT with large variability in the definitions used and poor reporting of the rationale and implementation of definitions. This variation impacts on research reproducibility, comparability of findings and the development of strategies aiming to curb therapy that is not guideline-recommended.
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Affiliation(s)
| | - Claudia Bruno
- Centre for Big Data Research in Health, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Navya Baranwal
- Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Timothy A Dobbins
- National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia.,Menzies Centre for Health Policy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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18
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Prevalence and Risk Factors for Chronic Abdominal Pain After Roux-en-Y Gastric Bypass Surgery: A Cohort Study. Ann Surg 2021; 273:306-314. [PMID: 31058699 DOI: 10.1097/sla.0000000000003356] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate the prevalence and risk factors for chronic abdominal pain after Roux-en-Y gastric bypass (RYGB) surgery. SUMMARY BACKGROUND DATA Abdominal pain is a frequent postoperative complication after RYGB surgery. Even if there have been defined several long-term complications, the literature regarding patients with unexplained chronic abdominal pain is sparse. METHODS A single-center register-based cohort study with inclusion of all patients who underwent RYGB surgery between 2010 and 2015. Data from multiple registries, medical records, and a questionnaire were used. Patients with chronic abdominal pain were defined as those using strong analgesics, diagnosed with chronic pain, or referred to a specialized pain clinic. Patients with severe self-reported abdominal pain were defined as those reporting abdominal pain more than 2 times weekly within the last month. RESULTS A total of 787 patients were followed for a median of 63 months. The prevalence of postoperative chronic abdominal pain was 11% and the prevalence of severe self-reported abdominal pain was 21%. Preoperative use of strong analgesics was a risk factor for chronic abdominal pain (OR, 2.26; 95% CI, 1.59-3.23) and severe self-reported abdominal pain (OR 2.82, 95% CI 1.64-4.84). Further risk factors for severe self-reported pain were unemployment or retirement (OR 1.80, 95% CI 1.09-2.93), postoperative complications (OR 2.75, 95% CI 1.44-5.22), and smoking (OR 1.80, 95% CI 1.09-2.96). CONCLUSIONS One in 10 patients undergoing RYGB surgery developed chronic abdominal pain requiring strong analgesics, and one in five suffered from severe abdominal pain. Risk factors were preoperative use of strong analgesics, unemployment, postoperative complications, and smoking.
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19
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Béliveau A, Castilloux AM, Tannenbaum C, Vincent P, de Moura CS, Bernatsky S, Moride Y. Predictors of long-term use of prescription opioids in the community-dwelling population of adults without a cancer diagnosis: a retrospective cohort study. CMAJ Open 2021; 9:E96-E106. [PMID: 33563639 PMCID: PMC8034379 DOI: 10.9778/cmajo.20200076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Long-term opioid use is a known risk factor for opioid-related harms. We aimed to identify risk factors for and predictors of long-term use of prescription opioids in the community-dwelling population of adults without a diagnosis of cancer, to inform practice change at the point of care. METHODS Using Quebec administrative claims databases, we conducted a retrospective cohort study in a random sample of adult members (≥ 18 yr) of the public drug plan who did not have a cancer diagnosis and who initiated a prescription opioid in the outpatient setting between Jan. 1, 2012, and Dec. 31, 2016. The outcome of interest was long-term opioid use (≥ 90 consecutive days or ≥ 120 cumulative days over 12 mo). Potential predictors included sociodemographic factors, medical history, characteristics of the initial opioid prescription and prescriber's specialty. We used multivariable logistic regression to assess the association between each characteristic and long-term use. We used the area under the receiver operating characteristic curve to determine the predictive performance of full and parsimonious models. RESULTS Of 124 664 eligible patients who initiated opioid therapy, 4172 (3.3%) progressed to long-term use of prescription opioids. The most important associated factors in the adjusted analysis were long-term prescription of acetaminophen-codeine (odds ratio [OR] 6.30, 95% confidence interval [CI] 4.99 to 7.96), prescription of a long-acting opioid at initiation (OR 6.02, 95% CI 5.31 to 6.84), initial supply of 30 days or more (OR 4.22, 95% CI 3.81 to 4.69), chronic pain (OR 2.41, 95% CI 2.16 to 2.69) and initial dose of at least 90 morphine milligram equivalents (MME) per day (OR 1.24, 95% CI 1.04 to 1.47). Our predictive model, including only the initial days' supply and chronic pain diagnosis, had area under the curve of 0.7618. INTERPRETATION This study identified factors associated with long-term prescription opioid use. Limiting the initial supply to no more than 7 days and limiting doses to 90 MME/day or less are actions that could be undertaken at the point of care.
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Affiliation(s)
- Audrey Béliveau
- Faculty of Pharmacy (Béliveau, Castilloux, Tannenbaum, Vincent, Moride), Université de Montréal; Institut universitaire de gériatrie de Montréal (Tannenbaum); Department of Pharmacy (Vincent), Institut universitaire en santé mentale de Montréal; Division of Clinical Epidemiology (Soares de Moura, Bernatsky), McGill University, Montréal, Que.; Rutgers, The State University of New Jersey (Moride), New Brunswick, NJ
| | - Anne-Marie Castilloux
- Faculty of Pharmacy (Béliveau, Castilloux, Tannenbaum, Vincent, Moride), Université de Montréal; Institut universitaire de gériatrie de Montréal (Tannenbaum); Department of Pharmacy (Vincent), Institut universitaire en santé mentale de Montréal; Division of Clinical Epidemiology (Soares de Moura, Bernatsky), McGill University, Montréal, Que.; Rutgers, The State University of New Jersey (Moride), New Brunswick, NJ
| | - Cara Tannenbaum
- Faculty of Pharmacy (Béliveau, Castilloux, Tannenbaum, Vincent, Moride), Université de Montréal; Institut universitaire de gériatrie de Montréal (Tannenbaum); Department of Pharmacy (Vincent), Institut universitaire en santé mentale de Montréal; Division of Clinical Epidemiology (Soares de Moura, Bernatsky), McGill University, Montréal, Que.; Rutgers, The State University of New Jersey (Moride), New Brunswick, NJ
| | - Philippe Vincent
- Faculty of Pharmacy (Béliveau, Castilloux, Tannenbaum, Vincent, Moride), Université de Montréal; Institut universitaire de gériatrie de Montréal (Tannenbaum); Department of Pharmacy (Vincent), Institut universitaire en santé mentale de Montréal; Division of Clinical Epidemiology (Soares de Moura, Bernatsky), McGill University, Montréal, Que.; Rutgers, The State University of New Jersey (Moride), New Brunswick, NJ
| | - Cristiano Soares de Moura
- Faculty of Pharmacy (Béliveau, Castilloux, Tannenbaum, Vincent, Moride), Université de Montréal; Institut universitaire de gériatrie de Montréal (Tannenbaum); Department of Pharmacy (Vincent), Institut universitaire en santé mentale de Montréal; Division of Clinical Epidemiology (Soares de Moura, Bernatsky), McGill University, Montréal, Que.; Rutgers, The State University of New Jersey (Moride), New Brunswick, NJ
| | - Sasha Bernatsky
- Faculty of Pharmacy (Béliveau, Castilloux, Tannenbaum, Vincent, Moride), Université de Montréal; Institut universitaire de gériatrie de Montréal (Tannenbaum); Department of Pharmacy (Vincent), Institut universitaire en santé mentale de Montréal; Division of Clinical Epidemiology (Soares de Moura, Bernatsky), McGill University, Montréal, Que.; Rutgers, The State University of New Jersey (Moride), New Brunswick, NJ
| | - Yola Moride
- Faculty of Pharmacy (Béliveau, Castilloux, Tannenbaum, Vincent, Moride), Université de Montréal; Institut universitaire de gériatrie de Montréal (Tannenbaum); Department of Pharmacy (Vincent), Institut universitaire en santé mentale de Montréal; Division of Clinical Epidemiology (Soares de Moura, Bernatsky), McGill University, Montréal, Que.; Rutgers, The State University of New Jersey (Moride), New Brunswick, NJ
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20
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De Sola H, Dueñas M, Salazar A, Ortega-Jiménez P, Failde I. Prevalence of Therapeutic use of Opioids in Chronic non-Cancer Pain Patients and Associated Factors: A Systematic Review and Meta-Analysis. Front Pharmacol 2020; 11:564412. [PMID: 33364942 PMCID: PMC7750787 DOI: 10.3389/fphar.2020.564412] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/16/2020] [Indexed: 02/01/2023] Open
Abstract
Objectives: To determine the prevalence and factors associated with the use of opioids among patients with chronic non-cancer pain (CNCP). Methods: A systematic review and meta-analysis. Comprehensive literature searches in Medline-PubMed, Embase and SCOPUS databases. Original studies published between 2009 and 2019 with a cross-sectional design were included. The quality of the studies was assessed with Critical Appraisal Checklist for Studies Reporting Prevalence Data from the Joanna Briggs Institute. Protocol registered in the International Prospective Register of Systematic Reviews with reference number: CRD42019137990. Results: Out of the 1,310 potential studies found, 25 studies fulfilled the inclusion criteria. Most of the studies were of high quality. High levels of heterogeneity were found in the studies included. In the general population, the prevalence of long-term opioid use was 2.3% (95% CI: 1.5–3.6%), the prevalence of short-term opioid use was 8.1% (95% CI: 5.6–11.6%), and among people with chronic low back pain it was 5.8% (95% CI: 0.5–45.5%). The prevalence of opioid use among patients from the health records or medical surveys was 41% (95% CI: 23.3–61.3%). Finally, in patients with musculoskeletal pain, the prevalence was 20.5% (95% CI: 12.9–30.9%) and in patients with fibromyalgia, 24.5% (95% CI: 22.9–26.2%). A higher prevalence of opioid use was observed among men, younger people, patients receiving prescriptions of different types of drugs, smokers and patients without insurance or with noncommercial insurance. In addition, non-white and Asian patients were less likely to receive opioids than non-Hispanic white patients. Conclusions: The prevalence of opioid use among patients with CNCP was higher in subjects with short or occasional use compared to those with long-term use. Men, younger people, more chronic pain conditions, and patients without insurance or with noncommercial insurance were most related to opioid use. However, non-white and Asian patients, and those treated by a physician trained in complementary medicine were less likely to use opioids.
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Affiliation(s)
- Helena De Sola
- The Observatory of Pain, University of Cádiz, Cádiz, Spain.,Preventive Medicine and Public Health Area, University of Cádiz, Cádiz, Spain.,Biomedical Research and Innovation Institute of Cádiz (INiBICA), Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain
| | - María Dueñas
- The Observatory of Pain, University of Cádiz, Cádiz, Spain.,Biomedical Research and Innovation Institute of Cádiz (INiBICA), Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain.,Department of Statistics and Operational Research, University of Cádiz, Cádiz, Spain
| | - Alejandro Salazar
- The Observatory of Pain, University of Cádiz, Cádiz, Spain.,Biomedical Research and Innovation Institute of Cádiz (INiBICA), Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain.,Department of Statistics and Operational Research, University of Cádiz, Cádiz, Spain
| | - Patricia Ortega-Jiménez
- The Observatory of Pain, University of Cádiz, Cádiz, Spain.,Department of Statistics and Operational Research, University of Cádiz, Cádiz, Spain
| | - Inmaculada Failde
- The Observatory of Pain, University of Cádiz, Cádiz, Spain.,Preventive Medicine and Public Health Area, University of Cádiz, Cádiz, Spain.,Biomedical Research and Innovation Institute of Cádiz (INiBICA), Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain
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21
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Sani AR, Zin CS. Comparison of the Clinical Outcomes between Short-term and Long-term Opioid Users with Noncancer Pain at Pain Clinics. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2020; 12:S728-S732. [PMID: 33828368 PMCID: PMC8021069 DOI: 10.4103/jpbs.jpbs_284_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/09/2020] [Accepted: 04/21/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The clinical use of opioids for long-term for noncancer pain indications remains a controversy. More studies are needed for evidence-based guidelines in noncancer pain management involving opioids. The primary objective of this study was to investigate the clinical outcomes of the short-term and long-term opioid use among patients with noncancer pain. MATERIALS AND METHODS This is a retrospective cross-sectional study where patients (aged ≥18 years) with noncancer pain treated with opioids were recruited from three pain clinics in Malaysia. Data on patients' opioid use were collected from prescription records. The individual days covered with opioids per patient were calculated and based on this, patients were classified as short-term (<90 days) or long-term (≥90 days) opioid user. Outcome measures included pain intensity and pain interference with daily activities assessed by Brief Pain Inventory - Short Form (BPI-SF), health-related quality of life (HRQoL) assessed by 36-Item Short Form Health Survey version 2 (SF-36v2). These measures were compared between short-term and long-term opioid users. RESULTS Of the 61 noncancer pain patients recruited, 49.2% (n = 30/61) were short-term and 50.8% (n = 31/61) were long-term opioid users. There were no statistically significant differences in the mean scores of pain intensity, pain interference with daily activities, and HRQoL between short-term and long-term opioid users in this study. CONCLUSION Findings of this study imply that long-term opioid therapy does not provide significant pain relief or improvement in patients' functional capability and HRQoL in noncancer pain patients. Future prospective studies with larger sample sizes are needed to support the findings of this study.
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Affiliation(s)
- Asween R Sani
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia (IIUM), Kuantan, Pahang, Malaysia
| | - Che Suraya Zin
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia (IIUM), Kuantan, Pahang, Malaysia
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22
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Associations of mental health and family background with opioid analgesic therapy: a nationwide Swedish register-based study. Pain 2020; 160:2464-2472. [PMID: 31339870 DOI: 10.1097/j.pain.0000000000001643] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
There is evidence of greater opioid prescription to individuals in the United States with mental health conditions. Whether these associations generalize beyond the US prescription environment and to familial mental health and socioeconomic status (SES) has not been examined comprehensively. This study estimated associations of diverse preexisting mental health diagnoses, parental mental health history, and SES in childhood with opioid analgesic prescription patterns nationwide in Sweden. Using register-based data, we identified 5,071,193 (48.4% female) adolescents and adults who were naive to prescription opioid analgesics and followed them from 2007 to 2014. The cumulative incidence of any dispensed opioid analgesic within 3 years was 11.4% (95% CI, 11.3%-11.4%). Individuals with preexisting self-injurious behavior, as well as opioid and other substance use, attention-deficit/hyperactivity, depressive, anxiety, and bipolar disorders had greater opioid therapy initiation rates than did individuals without the respective conditions (hazard ratios from 1.24 [1.20-1.27] for bipolar disorder to 2.12 [2.04-2.21] for opioid use disorder). Among 1,298,083 opioid recipients, the cumulative incidence of long-term opioid therapy (LTOT) was 7.6% (7.6%-7.7%) within 3 years of initiation. All mental health conditions were associated with greater LTOT rates (hazard ratios from 1.66 [1.56-1.77] for bipolar disorder to 3.82 [3.51-4.15] for opioid use disorder) and were similarly associated with concurrent benzodiazepine-opioid therapy. Among 1,482,462 adolescents and young adults, initiation and LTOT rates were greater for those with parental mental health history or lower childhood SES. Efforts to understand and ameliorate potential adverse effects of opioid analgesics must account for these patterns.
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23
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Mathieson S, Wertheimer G, Maher CG, Christine Lin CW, McLachlan AJ, Buchbinder R, Pearson SA, Underwood M. What proportion of patients with chronic noncancer pain are prescribed an opioid medicine? Systematic review and meta-regression of observational studies. J Intern Med 2020; 287:458-474. [PMID: 32100394 DOI: 10.1111/joim.13026] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/09/2019] [Accepted: 01/15/2020] [Indexed: 01/01/2023]
Abstract
Guidelines now discourage opioid analgesics for chronic noncancer pain because the benefits frequently do not outweigh the harms. We aimed to determine the proportion of patients with chronic noncancer pain who are prescribed an opioid, the types prescribed and factors associated with prescribing. Database searches were conducted from inception to 29 October 2018 without language restrictions. We included observational studies of adults with chronic noncancer pain measuring opioid prescribing. Opioids were categorized as weak (e.g. codeine) or strong (e.g. oxycodone). Study quality was assessed using a risk of bias tool designed for observational studies measuring prevalence. Individual study results were pooled using a random-effects model. Meta-regression investigated study-level factors associated with prescribing (e.g. sampling year, geographic region as per World Health Organization). The overall evidence quality was assessed using Grading of Recommendations Assessment, Development and Evaluation criteria. Of the 42 studies (5,059,098 participants) identified, the majority (n = 28) were from the United States of America. Eleven studies were at low risk of bias. The pooled estimate of the proportion of patients with chronic noncancer pain prescribed opioids was 30.7% (95% CI 28.7% to 32.7%, n = 42 studies, moderate-quality evidence). Strong opioids were more frequently prescribed than weak (18.4% (95% CI 16.0-21.0%, n = 15 studies, low-quality evidence), versus 8.5% (95% CI 7.2-9.9%, n = 15 studies, low-quality evidence)). Meta-regression determined that opioid prescribing was associated with year of sampling (more prescribing in recent years) (P = 0.014) and not geographic region (P = 0.056). Opioid prescribing for patients with chronic noncancer pain is common and has increased over time.
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Affiliation(s)
- S Mathieson
- From the, Institute for Musculoskeletal Health, Sydney, NSW, Australia.,Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - G Wertheimer
- School of Medicine, University of Notre Dame, Sydney, NSW, Australia
| | - C G Maher
- From the, Institute for Musculoskeletal Health, Sydney, NSW, Australia.,Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - C-W Christine Lin
- From the, Institute for Musculoskeletal Health, Sydney, NSW, Australia.,Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - A J McLachlan
- Faculty of Medicine and Health, Sydney Pharmacy School, The University of Sydney, Sydney, NSW, Australia
| | - R Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Vic.,, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - S-A Pearson
- Medicines Policy Research Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - M Underwood
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.,University Hospitals of Coventry and Warwickshire, Coventry, UK
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24
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Ljungvall H, Rhodin A, Wagner S, Zetterberg H, Åsenlöf P. "My life is under control with these medications": an interpretative phenomenological analysis of managing chronic pain with opioids. BMC Musculoskelet Disord 2020; 21:61. [PMID: 32005212 PMCID: PMC6995209 DOI: 10.1186/s12891-020-3055-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 01/08/2020] [Indexed: 02/08/2023] Open
Abstract
Background The use of opioids to relieve chronic pain has increased during the last decades, but experiences of chronic opioid therapy (COT) (> 90 days) point at risks and loss of beneficial effects. Still, some patients report benefits from opioid medication, such as being able to stay at work. Guidelines for opioid use in chronic pain do not consider the individual experience of COT, including benefits and risks, making the first person perspective an important scientific component to explore. The aim of this study was to investigate the lived experience of managing chronic pain with opioids in a sample who have severe chronic pain but are able to manage their pain sufficiently to remain at work. Methods We used a qualitative research design: interpretative phenomenological analysis. Ten individuals with chronic pain and opioid therapy were purposively sampled in Swedish tertiary care. Results Three super-ordinate themes emerged from the analyses: Without opioids, the pain becomes the boss; Opioids as a salvation and a curse, and Acknowledgement of the pain and acceptance of opioid therapy enables transition to a novel self. The participants used opioids to regain control over their pain, thus reclaiming their wanted life and self, and sense of control over one’s life-world. Using opioids to manage pain was not unproblematic and some of the participants had experienced a downward spiral of escalating pain and uncontrollable opioid use, and stigmatisation. Conclusions All participants emphasised the importance of control, regarding both pain and opioid use. To accomplish this, trust between participants and health care providers was essential for satisfactory treatment. Regardless of the potential sociocultural benefits of staying at work, participants had experiences of balancing positive and negative effects of opioid therapy, similar to what previous qualitative research has found. Measurable improvement of function and quality of life, may justify the long-term use of opioids in some cases. However, monitoring of adverse events should be mandatory. This requires close cooperation and a trusting relationship between the patients and their health care provider.
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Affiliation(s)
- Hanna Ljungvall
- Department of Neuroscience, Uppsala University, Box 593, 751 24, Uppsala, Sweden
| | - Annica Rhodin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Sofia Wagner
- Department of Neuroscience, Uppsala University, Box 593, 751 24, Uppsala, Sweden
| | - Hedvig Zetterberg
- Department of Neuroscience, Uppsala University, Box 593, 751 24, Uppsala, Sweden
| | - Pernilla Åsenlöf
- Department of Neuroscience, Uppsala University, Box 593, 751 24, Uppsala, Sweden.
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25
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Sani AR, Zin CS, Mohamed AH, Izat M, Tan HL, Ng KS, Nissen L. Exploration of change in persistence patterns of opioid use among patients with non‐cancer and cancer pain over a 3‐year follow‐up period. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2020. [DOI: 10.1002/jppr.1573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Asween R. Sani
- Department of Pharmacy Practice Kulliyyah of Pharmacy International Islamic University Malaysia Kuantan Malaysia
| | - Che S. Zin
- Department of Pharmacy Practice Kulliyyah of Pharmacy International Islamic University Malaysia Kuantan Malaysia
| | - Abdul H. Mohamed
- Department of Anaesthesiology and Critical Care Kulliyyah of Medicine International Islamic University Malaysia Kuantan Malaysia
| | - Munira Izat
- Department of Pharmacy Hospital Kuala Lumpur Kuala Lumpur Malaysia
| | - Hung L. Tan
- Department of Anaesthesiology, Intensive Care and Pain Management Hospital Kuala Lumpur Kuala Lumpur Malaysia
| | - Kim S. Ng
- Department of Anaesthesiology Intensive Care and Pain Management, Hospital Selayang Selangor Malaysia
| | - Lisa Nissen
- Faculty of Health School of Clinical Sciences Queensland University of Technology Brisbane Australia
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26
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Khodneva Y, Richman J, Kertesz S, Safford MM. Gender differences in association of prescription opioid use and mortality: A propensity-matched analysis from the REasons for Geographic And Racial Differences in Stroke (REGARDS) prospective cohort. Subst Abus 2019; 42:94-103. [PMID: 31860382 PMCID: PMC7305051 DOI: 10.1080/08897077.2019.1702609] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Prescription opioids (PO) have been widely used for chronic non-cancer pain, with commensurate concerns for overdose. The long-term effect of these medications on non-overdose mortality in the general population remains poorly understood. This study's objective was to examine the association of prescription opioid use and mortality in a large cohort, accounting for gender differences and concurrent benzodiazepine use, and using propensity score matching. Methods: 29,025 US community-dwellers were enrolled in the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort between 2003 and 2007, and followed through December 31, 2012. At baseline there were 1907 participants with PO; 1864 of them were matched to participants without PO, based on the model-derived propensity to receive opioid prescriptions. Causes of death were expert-adjudicated. Results: Over median follow-up of 6 years there were 4428 deaths (413 among persons with PO). The risk for all-cause mortality was 12% higher, in absolute terms, for persons with PO compared to those without PO in the overall sample, with gender differences (interaction p = .0008). The risk of death was increased for women with PO (hazard ratio [HR] 1.21 [95% Confidence Interval (CI) 1.04-1.40]), but not men (HR 0.92 [95% CI 0.77-1.10]). Women with PO were at higher risk of cardiovascular disease (CVD) death (HR 1.43 [95% CI 1.12-1.84]), sudden death (HR 2.02 [95% CI 1.29-3.15]) (a subset of CVD death), and accidents (HR 2.18 [95% CI 1.03-4.60]). These risks were not observed for men with PO. Conclusion: Over 6 years of follow-up, women but not men who had opioid prescriptions were at higher risk of all-cause mortality, CVD death, sudden death, and accidents. Special caution in prescribing opioids for women may be warranted until these findings are confirmed.
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Affiliation(s)
- Yulia Khodneva
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Joshua Richman
- Department of Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Stefan Kertesz
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Birmingham Veterans Administration Health Medical Center, Birmingham, Alabama, USA
| | - Monika M Safford
- Division of Internal Medicine, Weill Cornell University, New York, New York, USA
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27
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An observational study on risk factors for prolonged opioid prescription after severe trauma. Scand J Pain 2019; 20:345-351. [DOI: 10.1515/sjpain-2019-0095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 10/15/2019] [Indexed: 12/15/2022]
Abstract
Abstract
Background and aims:
Trauma is one of the most common causes of morbidity and mortality in people of working age. Following surgery, approximately 10% of patients develop persistent postsurgical pain. Chronic pain is a complex phenomenon that can adversely affect quality of life and is associated with psychiatric conditions such as anxiety and depression. Pharmacological treatment is normally insufficient to fully alleviate chronic pain and improve functional capacity, especially in the long term. The appropriateness of opioid treatment in chronic non-cancer pain has become increasingly examined with high numbers of serious side effects including drug dependency and death. The present study was based on clinical observations suggesting that a problematic opioid use can be initiated during trauma care, which implies the importance of evaluating opioid therapy and its effect on trauma patients. Specific attention is given to patients with known psychiatric conditions which may render them more vulnerable to develop problematic opioid use. The aim of this observational study was to broadly characterize patients referred to a pain specialist after severe trauma regarding their trauma type, psychiatric co-morbidity, and opioid prescription pattern. This was done to tentatively investigate possible risk factors for long-term opioid use following trauma.
Methods:
Trauma patients referred to the Pain Center at Karolinska University Hospital, Sweden (n=29) were recruited for the study over a period of 2 years. Demographic information, trauma-related data as well as psychiatric diagnoses and pharmacological prescriptions were retrieved from the registry SweTrau and electronic medical records.
Results:
Among the 29 participants (age range 21–55 years, median=34; 76% male), 14 (48%) were prescribed opioids at least once during the 6-months period preceding the trauma. For 21 patients (72%) opioids were prescribed 6 months after the trauma. One year after the trauma, 18 patients (62%) still had prescriptions for opioids corresponding to daily use or more, and two other patients used opioids intermittently. Twenty patients (69%) had psychiatric diagnoses before the trauma. According to the medical records, 17 patients (59%) received pharmacological treatment for psychiatric conditions in the six months period preceding the trauma. During the follow-up period, psychiatric pharmacological treatment was prescribed for 27 (93%) of the patients.
Conclusion and implications:
For most of the participants opioids were still being prescribed one year after trauma. The majority presented with psychiatric co-morbidity before trauma and were also prescribed psychiatric medication. Findings support the notion that patients with a complex pain situation in the acute phase following trauma are at risk for prolonged opioid prescription. These results, although tentative, point at psychiatric co-morbidity, opioid use before trauma, high injury severity, extensive surgery and extended hospital stay as risk factors for prolonged opioid prescription after severe trauma. This study is purely observational, with a small sample and non-controlled design. However, these data further emphasize the need to identify patients at risk for developing problematic long-term opioid use following trauma and to ensure appropriate pain treatment.
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28
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Almutairi AR, Mollon L, Lee J, Slack M. A comparison of the pharmacologic and nonpharmacologic strategies used to manage chronic pain: Opioid users versus nonusers. J Am Pharm Assoc (2003) 2019; 59:691-697. [DOI: 10.1016/j.japh.2019.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/10/2019] [Accepted: 06/04/2019] [Indexed: 11/28/2022]
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29
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Wisløff‐Aase K, Ræder J, Månum G, Løvstad M, Schanke A, Dyb G, Ekeberg Ø, Stanghelle JK. Chronic pain among the hospitalized patients after the 22 July 2011 terror attacks in Oslo and at Utøya Island. Acta Anaesthesiol Scand 2019; 63:913-922. [PMID: 30968401 DOI: 10.1111/aas.13373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 01/16/2019] [Accepted: 03/13/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND On 22 July 2011, 48 people were hospitalized due to physical injuries from gun shots or explosion, following 2 terror attacks in the Oslo area, Norway. In this study, we have investigated the occurrence of chronic pain, the severity and consequences of chronic pain in these patients, 3 to 4 years after the incidents. METHODS Totally 43 eligible terror trauma patients were invited to participate in the study, 30 patients were included. They underwent a consultation with a psychologist and a physician; containing psychological assessment, neuropsychological screening, a standardized clinical interview, medical examination, and a pain protocol. RESULTS In 18 (60%) the injury was severe, as defined by New Injury Severity Score > 15. Twenty-four patients (80%) reported injury-related chronic pain after the trauma, in 22 with consequences on daily life. Analgesics were used by 20 patients, including 5 in need of opioids. Ten patients had unmet needs of further specialist pain care. In 12 patients, the average pain score last week was above three on a 0-10 Numeric Rating Scale. In these patients, clinical signs of neuropathic pain were evident in 10, as tested by the Douleur Neuropathique score. There were significant correlations (P < 0.05) between severity of chronic pain and presence of post-traumatic stress symptoms, reduced quality of life, reduced psychosocial and physical function; but no correlation with pre-injury patient characteristics or the degree of physical injury. CONCLUSION Chronic pain was frequent and significant, irrespective of injury severity, in these patients who obtained their physical injuries under extreme psychological conditions.
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Affiliation(s)
- Kristin Wisløff‐Aase
- Department of Anaesthesiology Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine, Faculty of Medicine University of Oslo Oslo Norway
| | - Johan Ræder
- Department of Anaesthesiology Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine, Faculty of Medicine University of Oslo Oslo Norway
| | - Grethe Månum
- Institute of Clinical Medicine, Faculty of Medicine University of Oslo Oslo Norway
- Sunnaas Rehabilitation Hospital Nesodden Norway
| | - Marianne Løvstad
- Sunnaas Rehabilitation Hospital Nesodden Norway
- Department of Psychology University of Oslo Oslo Norway
| | - Anne‐Kristine Schanke
- Sunnaas Rehabilitation Hospital Nesodden Norway
- Department of Psychology University of Oslo Oslo Norway
| | - Grete Dyb
- Institute of Clinical Medicine, Faculty of Medicine University of Oslo Oslo Norway
- Norwegian Center for Violence and Traumatic Stress Studies Oslo Norway
| | - Øivind Ekeberg
- Division of Mental Health and Addiction Oslo University Hospital Oslo Norway
- Department of Behavioral Sciences in Medicine, Faculty of Medicine University of Oslo Oslo Norway
| | - Johan Kvalvik Stanghelle
- Institute of Clinical Medicine, Faculty of Medicine University of Oslo Oslo Norway
- Sunnaas Rehabilitation Hospital Nesodden Norway
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30
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Axon DR, Patel MJ, Martin JR, Slack MK. Use of multidomain management strategies by community dwelling adults with chronic pain: evidence from a systematic review. Scand J Pain 2019; 19:9-23. [PMID: 30375350 DOI: 10.1515/sjpain-2018-0306] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 10/10/2018] [Indexed: 12/18/2022]
Abstract
Background and aims Multidomain strategies (i.e. two or more strategies) for managing chronic pain are recommended to avoid excessive use of opioids while producing the best outcomes possible. The aims of this systematic review were to: 1) determine if patient-reported pain management is consistent with the use of multidomain strategies; and 2) identify the role of opioids and non-steroidal anti-inflammatory drugs (NSAIDs) in patient-reported pain management. Methods Bibliographic databases, websites, and reference lists of included studies were searched to identify published articles reporting community-based surveys of pain self-management from January 1989 to June 2017 using controlled vocabulary (and synonyms): pain; self-care; self-management; self-treatment; and adult. Two independent reviewers screened studies and extracted data on subject demographics, pain characteristics, pain self-management strategies, and pain outcomes. Pain self-management strategies were organized according to our conceptual model. Included studies were assessed for risk of bias. Differences between the researchers were resolved by consensus. Results From the 3,235 unique records identified, 18 studies published between 2002 and 2017 from 10 countries were included. Twenty-two types of pharmacological strategies were identified (16 prescription, six non-prescription). NSAIDs (15 studies, range of use 10-72%) and opioids (12 studies, range of use 5-72%) were the most commonly reported prescription pharmacological strategies. Other prescription pharmacological strategies included analgesics, acetaminophen, anticonvulsants, antidepressants, anxiolytics, salicylates, β-blockers and calcium channel blockers, disease-modifying anti-rheumatic drugs and steroids, muscle relaxants, topical products, triptans, and others. Twenty-two types of non-pharmacological strategies were identified: four medical strategies (10 studies), 10 physical strategies (15 studies), four psychological strategies (12 studies), and four self-initiated strategies (15 studies). Medical strategies included consulting a medical practitioner, chiropractic, and surgery. Physical strategies included exercise, massage, hot and cold modalities, acupuncture, physical therapy, transcutaneous electrical nerve stimulation, activity modification or restriction, assistive devices, and altering body position/posture. Psychological strategies included relaxation, prayer or meditation, therapy, and rest/sleep. Self-initiated strategies included dietary or herbal supplements, dietary modifications, and complementary and alternative medicine. Overall, the number of strategies reported among the studies ranged from five to 28 (out of 44 identified strategies). Limited data on pain outcomes was reported in 15 studies, and included satisfaction with pain management strategies, pain interference on daily activities, adverse events, lost work or restricted activity days, emergency department visits, and disabilities. Conclusions A wide variety and large number of pharmacological and non-pharmacological strategies to manage chronic pain were reported, consistent with the use of multidomain strategies. High levels of use of both NSAIDs and opioids also were reported. Implications Comprehensive review and consultation with patients about their pain management strategies is likely needed for optimal outcomes. Additional research is needed to determine: how many, when, and why multidomain strategies are used; the relationship between opioid use, multidomain management strategies, and level of pain; how multidomain strategies relate to outcomes; and if adding strategies to a pain management plan increases the risk of adverse events or interactions, and increases an individuals pain management burden.
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Affiliation(s)
- David R Axon
- Department of Pharmacy Practice and Science, The University of Arizona College of Pharmacy, 1295 N. Martin Avenue, Tucson, AZ 85721, USA
| | - Mira J Patel
- Department of Pharmacy Practice and Science, The University of Arizona College of Pharmacy, Tucson, AZ, USA
| | - Jennifer R Martin
- Department of Pharmacy Practice and Science, The University of Arizona College of Pharmacy, Tucson, AZ, USA.,University of Arizona Health Sciences Library, The University of Arizona, Tucson, AZ, USA
| | - Marion K Slack
- Department of Pharmacy Practice and Science, The University of Arizona College of Pharmacy, Tucson, AZ, USA
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31
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Berthelot JM, Nizard J, Maugars Y. The negative Hawthorne effect: Explaining pain overexpression. Joint Bone Spine 2019; 86:445-449. [DOI: 10.1016/j.jbspin.2018.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2018] [Indexed: 10/28/2022]
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32
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Chen TC, Chen LC, Kerry M, Knaggs RD. Prescription opioids: Regional variation and socioeconomic status - evidence from primary care in England. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 64:87-94. [PMID: 30641450 DOI: 10.1016/j.drugpo.2018.10.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/14/2018] [Accepted: 10/22/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND This study aimed to quantify opioid prescriptions dispensed from primary care practices throughout England and investigate its association with socioeconomic status (SES). METHODS This cross-sectional study used publicly available data in 2015, including practice-level dispensing data and characteristics of registrants from the United Kingdom (UK) National Health Service Digital, and Index of Multiple Deprivation (IMD) data from Department of Communities and Local Government. Practices in England which issued opioid prescriptions that could be assigned a defined daily dose (DDD) in the claim-based dispensing database were included. The total amount of opioid prescriptions dispensed (DDD/1000 registrants/day) was calculated for each practice. The association between dispensed opioid prescriptions and IMD was analyzed by multi-level regression and adjusted for registrants' characteristics and the clustered effect of Clinical Commissioning Groups. Subgroup analysis was conducted for practices in London, Birmingham, Manchester and Newcastle. RESULTS Of the 7856 included practices in England, the median and interquartile range (IQR) of prescription opioids dispensed was 36.9 (IQR: 23.1, 52.5) DDD/1000 registrants/day. The median opioid utilization (DDD/1000 registrants/day) amongst practices varied between Manchester (53.1; IQR: 36.8, 71.4), Newcastle (48.9; IQR: 38.8, 60.1), Birmingham (35.3; IQR: 23.1, 49.4) and London (13.9; IQR: 8.1, 18.8). Lower SES, increased prevalence of patients aged more than 65 years, female gender, smoking, obesity and depression were significantly associated with increased opioid prescriptions. For every decrease in IMD decile (lower SES), there was a significant increase of opioid utilization by 1.0 (95% confidence interval: 0.89, 1.2, P < 0.001) DDD/1000 registrants/day. CONCLUSION There was substantial variation in opioid prescriptions among practices from Northern and Eastern England to Southern England. A significant association between increased opioid prescriptions and greater deprivation at a population level was observed. Further longitudinal studies using individual patient data are needed to validate this association and identify the potential mechanisms.
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Affiliation(s)
- Teng-Chou Chen
- Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, East Drive, University Park, Nottingham NG7 2RD, United Kingdom.
| | - Li-Chia Chen
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre Stopford Building, Oxford Road, Manchester M13 9PT, United Kingdom.
| | - Miriam Kerry
- Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, East Drive, University Park, Nottingham NG7 2RD, United Kingdom.
| | - Roger David Knaggs
- Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, East Drive, University Park, Nottingham NG7 2RD, United Kingdom; Primary Integrated Community Solutions, Unit 4 Ash Tree Court, Nottingham Business Park, Nottingham NG6 8PY, United Kingdom.
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Veiga DR, Mendonça L, Sampaio R, Castro-Lopes JM, Azevedo LF. A Two-Year Prospective Multicenter Study of Opioid Therapy for Chronic Noncancer Pain: Prescription Trends and Predictors. PAIN MEDICINE 2018; 20:2166-2178. [DOI: 10.1093/pm/pny275] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
Opioid use in chronic pain has increased worldwide in recent years. The aims of this study were to describe the trends and patterns of opioid therapy over two years of follow-up in a cohort of chronic noncancer pain (CNCP) patients and to assess predictors of long-term opioid use and clinical outcomes.
Methods
A prospective cohort study with two years of follow-up was undertaken in four multidisciplinary chronic pain clinics. Demographic data, pain characteristics, and opioid prescriptions were recorded at baseline, three, six, 12, and 24 months.
Results
Six hundred seventy-four CNCP patients were recruited. The prevalence of opioid prescriptions at baseline was 59.6% (N = 402), and 13% (N = 86) were strong opioid prescriptions. At 24 months, opioid prescription prevalence was as high as 74.3% (N = 501), and strong opioid prescription was 31% (N = 207). Most opioid users (71%, N = 479) maintained their prescription during the two years of follow-up. Our opioid discontinuation was very low (1%, N = 5). Opioid users reported higher severity and interference pain scores, both at baseline and after two years of follow-up. Opioid use was independently associated with continuous pain, pain location in the lower limbs, and higher pain interference scores.
Conclusions
This study describes a pattern of increasing opioid prescription in chronic pain patients. Despite the limited improvement of clinical outcomes, most patients keep their long-term opioid prescriptions. Our results underscore the need for changes in clinical practice and further research into the effectiveness and safety of chronic opioid therapy for CNPC.
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Affiliation(s)
- Dalila R Veiga
- Anesthesiology Department-Chronic Pain Center, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Liliane Mendonça
- Centro Nacional de Observação em Dor – OBSERVDOR, Porto, Portugal
| | - Rute Sampaio
- Departamento de Biomedicina - Unidade de Biologia Experimental, Faculdade de Medicina da Universidade do Porto, Portugal
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- IBMC—Instituto de Biologia Molecular e Celular, Universidade do Porto, Porto, Portugal
- Porto, Portugal
| | - José M Castro-Lopes
- Centro Nacional de Observação em Dor – OBSERVDOR, Porto, Portugal
- Departamento de Biomedicina - Unidade de Biologia Experimental, Faculdade de Medicina da Universidade do Porto, Portugal
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- IBMC—Instituto de Biologia Molecular e Celular, Universidade do Porto, Porto, Portugal
| | - Luís F Azevedo
- Centro Nacional de Observação em Dor – OBSERVDOR, Porto, Portugal
- CINTESIS - Center for Health Technology and Services Research, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- MEDCIDS - Departamento de Medicina da Comunidade Informação e Decisão em Saúde, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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Häuser W, Schubert T, Scherbaum N, Tölle T. Langzeitopioidtherapie von nichttumorbedingten Schmerzen. Schmerz 2018; 32:419-426. [DOI: 10.1007/s00482-018-0324-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Association of opioid prescribing practices with chronic pain and benzodiazepine co-prescription: a primary care data linkage study. Br J Anaesth 2018; 120:1345-1355. [DOI: 10.1016/j.bja.2018.02.022] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 01/29/2018] [Accepted: 02/19/2018] [Indexed: 02/07/2023] Open
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Saïdi H, Pagé MG, Boulanger A, Ware MA, Choinière M. Effectiveness of long-term opioid therapy among chronic non-cancer pain patients attending multidisciplinary pain treatment clinics: A Quebec Pain Registry study. Can J Pain 2018; 2:113-124. [PMID: 35005371 PMCID: PMC8730575 DOI: 10.1080/24740527.2018.1451252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 03/05/2018] [Accepted: 03/08/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of this study was to investigate in a real-life context the effectiveness of long-term opioid therapy for reducing pain intensity and interference and improving health-related quality of life (QOL) in patients with chronic noncancer pain. METHODS Participants were 893 patients (age = 52.4 ± 14.1, female = 62.4%) enrolled in the Quebec Pain Registry (2008-2011) who completed questionnaires before their first visit at one of three multidisciplinary pain management clinics and 6 and 12 months thereafter. Based on their opioid use profile (OUP), patients were categorized as nonusers, non-lasting users, or lasting users. Data were analyzed using generalized estimating equations. RESULTS More than 60% of patients newly initiated on opioid therapy stopped their medication mainly because of adverse effects and/or lack of pain relief. OUP significantly predicted pain intensity and interference and physical QOL (pQOL; P values < 0.001). Lasting users of opioids reported higher levels of pain intensity and interference and poorer pQOL than nonusers and/or non-lasting users over the 12-month follow-up (P values < 0.001). However, all effect sizes were small, thus questioning the clinical significance of these group differences. Among lasting users, more than 20% of patients experienced a meaningful amelioration in pain intensity and interference as well as mental QOL (mQOL), whereas only 8% exhibited improved pQOL. DISCUSSION A significant subgroup of patients may benefit from long-term opioid therapy in terms of pain severity and mQOL but the majority do not. The challenge facing clinicians is how to identify who the responders will be.
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Affiliation(s)
- Hichem Saïdi
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
- Department of Pharmacology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - M. Gabrielle Pagé
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
- Department of Biomedical Sciences, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Aline Boulanger
- Department of Anesthesiology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Centre d’expertise en gestion de la douleur du Réseau universitaire intégré en santé de l’Université de Montréal, Montreal, Quebec, Canada
- Québec Pain Research Network
| | - Mark A. Ware
- Québec Pain Research Network
- Alan Edwards Center for Research on Pain, McGill University, Montreal, Quebec, Canada
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Department of Anesthesia, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Manon Choinière
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
- Québec Pain Research Network
- Alan Edwards Center for Research on Pain, McGill University, Montreal, Quebec, Canada
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Long-term use of opioids for nonmalignant pain among community-dwelling persons with and without Alzheimer disease in Finland: a nationwide register-based study. Pain 2017; 158:252-260. [PMID: 28092324 DOI: 10.1097/j.pain.0000000000000752] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Persons with Alzheimer disease (AD) commonly present with chronic nonmalignant pain, but long-term use of opioids among this population has not been studied previously. Our aim was to investigate the prevalence of long-term (≥180 days) use of opioids for nonmalignant pain and associated factors among community-dwelling persons with AD and to compare the prevalence with a matched cohort without AD. The Medication use and Alzheimer's disease (MEDALZ) cohort was used for this study, comprising all community-dwelling persons diagnosed with AD in Finland during 2005 to 2011 and their matched comparison persons without AD. After exclusion of persons with active cancer treatment, 62,074 persons with and 62,074 persons without AD were included in this study. Data were collected from nationwide registers. Opioids were used by 13,111 persons with and by 16,659 without AD. Overall long-term opioid use was more common among persons without AD (8.7%) than among persons with AD (7.2%, P < 0.0001). However, among opioid users, prevalence of long-term opioid use was slightly higher among persons with AD than among those without AD (34.2% vs 32.3%, respectively, P = 0.0004). Long-term use of transdermal opioids was more than 2-fold among opioid users with AD (13.2%) compared with users without AD (5.5%). Factors associated with long-term opioid use included AD, age ≥80 years, female sex, rheumatoid arthritis, osteoporosis, low socioeconomic position, history of substance abuse, and long-term benzodiazepine use. Prevalence of long-term opioid use was somewhat similar among both groups. Among persons with AD, long-term opioid use was strongly associated with transdermal opioids.
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Quinn PD, Hur K, Chang Z, Krebs EE, Bair MJ, Scott EL, Rickert ME, Gibbons RD, Kroenke K, D'Onofrio BM. Incident and long-term opioid therapy among patients with psychiatric conditions and medications: a national study of commercial health care claims. Pain 2017; 158:140-148. [PMID: 27984526 DOI: 10.1097/j.pain.0000000000000730] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
There is growing evidence that opioid prescribing in the United States follows a pattern in which patients who are at the highest risk of adverse outcomes from opioids are more likely to receive long-term opioid therapy. These patients include, in particular, those with substance use disorders (SUDs) and other psychiatric conditions. This study examined health insurance claims among 10,311,961 patients who filled prescriptions for opioids. Specifically, we evaluated how opioid receipt differed among patients with and without a wide range of preexisting psychiatric and behavioral conditions (ie, opioid and nonopioid SUDs, suicide attempts or other self-injury, motor vehicle crashes, and depressive, anxiety, and sleep disorders) and psychoactive medications (ie, antidepressants, benzodiazepines, hypnotics, mood stabilizers, antipsychotics, and medications used for SUD, tobacco cessation, and attention-deficit/hyperactivity disorder). Relative to those without, patients with all assessed psychiatric conditions and medications had modestly greater odds of subsequently filling prescriptions for opioids and, in particular, substantially greater risk of long-term opioid receipt. Increases in risk for long-term opioid receipt in adjusted Cox regressions ranged from approximately 1.5-fold for prior attention-deficit/hyperactivity disorder medication prescriptions (hazard ratio [HR] = 1.53; 95% confidence interval [CI], 1.48-1.58) to approximately 3-fold for prior nonopioid SUD diagnoses (HR = 3.15; 95% CI, 3.06-3.24) and nearly 9-fold for prior opioid use disorder diagnoses (HR = 8.70; 95% CI, 8.20-9.24). In sum, we found evidence of greater opioid receipt among commercially insured patients with a breadth of psychiatric conditions. Future studies assessing behavioral outcomes associated with opioid prescribing should consider preexisting psychiatric conditions.
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Affiliation(s)
- Patrick D Quinn
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, MN, USA.,Center for Health Statistics, University of Chicago, Chicago, IL, USA
| | - Kwan Hur
- Center for Health Statistics, University of Chicago, Chicago, IL, USA
| | - Zheng Chang
- Center for Health Statistics, University of Chicago, Chicago, IL, USA.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Erin E Krebs
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA.,University of Minnesota Medical School, Minneapolis, MN, USA
| | - Matthew J Bair
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA.,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.,Regenstrief Institute, Indianapolis, IN, USA
| | - Eric L Scott
- Department of Pediatrics and Communicable Diseases and Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Martin E Rickert
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, MN, USA
| | - Robert D Gibbons
- Center for Health Statistics, University of Chicago, Chicago, IL, USA
| | - Kurt Kroenke
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA.,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.,Regenstrief Institute, Indianapolis, IN, USA
| | - Brian M D'Onofrio
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, MN, USA
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Peng X, Studholme K, Kanjiya MP, Luk J, Bogdan D, Elmes MW, Carbonetti G, Tong S, Gary Teng YH, Rizzo RC, Li H, Deutsch DG, Ojima I, Rebecchi MJ, Puopolo M, Kaczocha M. Fatty-acid-binding protein inhibition produces analgesic effects through peripheral and central mechanisms. Mol Pain 2017; 13:1744806917697007. [PMID: 28326944 PMCID: PMC5407663 DOI: 10.1177/1744806917697007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background Fatty-acid-binding proteins (FABPs) are intracellular carriers for endocannabinoids, N-acylethanolamines, and related lipids. Previous work indicates that systemically administered FABP5 inhibitors produce analgesia in models of inflammatory pain. It is currently not known whether FABP inhibitors exert their effects through peripheral or central mechanisms. Here, we examined FABP5 distribution in dorsal root ganglia and spinal cord and examined the analgesic effects of peripherally and centrally administered FABP5 inhibitors. Results Immunofluorescence revealed robust expression of FABP5 in lumbar dorsal root ganglia. FABP5 was distributed in peptidergic calcitonin gene-related peptide-expressing dorsal root ganglia and non-peptidergic isolectin B4-expressing dorsal root ganglia. In addition, the majority of dorsal root ganglia expressing FABP5 also expressed transient receptor potential vanilloid 1 (TRPV1) and peripherin, a marker of nociceptive fibers. Intraplantar administration of FABP5 inhibitors reduced thermal and mechanical hyperalgesia in the complete Freund’s adjuvant model of chronic inflammatory pain. In contrast to its robust expression in dorsal root ganglia, FABP5 was sparsely distributed in the lumbar spinal cord and intrathecal administration of FABP inhibitor did not confer analgesic effects. Administration of FABP inhibitor via the intracerebroventricular (i.c.v.) route reduced thermal hyperalgesia. Antagonists of peroxisome proliferator-activated receptor alpha blocked the analgesic effects of peripherally and i.c.v. administered FABP inhibitor while antagonism of cannabinoid receptor 1 blocked the effects of peripheral FABP inhibition and a TRPV1 antagonist blocked the effects of i.c.v. administered inhibitor. Although FABP5 and TRPV1 were co-expressed in the periaqueductal gray region of the brain, which is known to modulate pain, knockdown of FABP5 in the periaqueductal gray using adeno-associated viruses and pharmacological FABP5 inhibition did not produce analgesic effects. Conclusions This study demonstrates that FABP5 is highly expressed in nociceptive dorsal root ganglia neurons and FABP inhibitors exert peripheral and supraspinal analgesic effects. This indicates that peripherally restricted FABP inhibitors may serve as a new class of analgesic and anti-inflammatory agents.
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Affiliation(s)
- Xiaoxue Peng
- 1 Department of Anesthesiology, Stony Brook University, Stony Brook, NY, USA
| | - Keith Studholme
- 1 Department of Anesthesiology, Stony Brook University, Stony Brook, NY, USA
| | - Martha P Kanjiya
- 1 Department of Anesthesiology, Stony Brook University, Stony Brook, NY, USA
| | - Jennifer Luk
- 1 Department of Anesthesiology, Stony Brook University, Stony Brook, NY, USA
| | - Diane Bogdan
- 1 Department of Anesthesiology, Stony Brook University, Stony Brook, NY, USA
| | - Matthew W Elmes
- 2 Department of Biochemistry and Cell Biology, Stony Brook University, Stony Brook, NY, USA
| | - Gregory Carbonetti
- 2 Department of Biochemistry and Cell Biology, Stony Brook University, Stony Brook, NY, USA
| | - Simon Tong
- 3 Department of Chemistry, Stony Brook University, Stony Brook, NY, USA.,4 Institute of Chemical Biology and Drug Discovery, Stony Brook University, Stony Brook, NY, USA
| | - Yu-Han Gary Teng
- 3 Department of Chemistry, Stony Brook University, Stony Brook, NY, USA.,4 Institute of Chemical Biology and Drug Discovery, Stony Brook University, Stony Brook, NY, USA
| | - Robert C Rizzo
- 4 Institute of Chemical Biology and Drug Discovery, Stony Brook University, Stony Brook, NY, USA.,5 Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA
| | - Huilin Li
- 2 Department of Biochemistry and Cell Biology, Stony Brook University, Stony Brook, NY, USA.,4 Institute of Chemical Biology and Drug Discovery, Stony Brook University, Stony Brook, NY, USA
| | - Dale G Deutsch
- 2 Department of Biochemistry and Cell Biology, Stony Brook University, Stony Brook, NY, USA.,4 Institute of Chemical Biology and Drug Discovery, Stony Brook University, Stony Brook, NY, USA
| | - Iwao Ojima
- 3 Department of Chemistry, Stony Brook University, Stony Brook, NY, USA.,4 Institute of Chemical Biology and Drug Discovery, Stony Brook University, Stony Brook, NY, USA
| | - Mario J Rebecchi
- 1 Department of Anesthesiology, Stony Brook University, Stony Brook, NY, USA
| | - Michelino Puopolo
- 1 Department of Anesthesiology, Stony Brook University, Stony Brook, NY, USA
| | - Martin Kaczocha
- 1 Department of Anesthesiology, Stony Brook University, Stony Brook, NY, USA.,2 Department of Biochemistry and Cell Biology, Stony Brook University, Stony Brook, NY, USA.,4 Institute of Chemical Biology and Drug Discovery, Stony Brook University, Stony Brook, NY, USA
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Pain sensitivity and analgesic use among 10,486 adults: the Tromsø study. BMC Pharmacol Toxicol 2017; 18:45. [PMID: 28599683 PMCID: PMC5466805 DOI: 10.1186/s40360-017-0149-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 05/24/2017] [Indexed: 12/11/2022] Open
Abstract
Background Increased pain sensitivity is a putative risk factor for chronic pain and consequently for analgesic use. Conversely, analgesic use may be a cause of increased pain sensitivity, e.g., through opioid-induced hyperalgesia. We aimed to study the association between pain sensitivity and analgesic use in a general population, and to test the hypothesis that increased baseline pain sensitivity is a risk factor for future persistent analgesic use. Methods The Tromsø Study (2007–08), a population-based health study, was linked with eight years of prescription data from the Norwegian Prescription Database. The cold pressor test was completed in 10,486 participants aged 30+ years, and we used cold pressor endurance time as a proxy measure of pain sensitivity. Cross-sectional associations with different measures of analgesic use were assessed. Furthermore, a cohort of 9,657 persons was followed for 4.5 years. Results In the cross-sectional analysis, increased pain sensitivity was associated with analgesic use; regular users of opioids alone were more pain sensitive than regular users of non-opioid analgesics. Increased baseline pain sensitivity was a risk factor for persistent analgesic use, i.e., using non-steroidal anti-inflammatory drugs, paracetamol, or opioids for ≥ 90 days and proportion-of-days-covered ≥ 40% (HR = 1.22, 95% CI 1.06-1.40), although not statistical significant after confounder adjustment. Conclusions Increased pain sensitivity was associated with analgesic use in general, and reduced pain tolerance was found for both opioid and non-opioid analgesic users. The data suggest that hyperalgesia is an effect of analgesics, whereas pain tolerance has little impact on future analgesic use. Electronic supplementary material The online version of this article (doi:10.1186/s40360-017-0149-2) contains supplementary material, which is available to authorized users.
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Birke H, Ekholm O, Sjøgren P, Kurita GP, Højsted J. Long-term opioid therapy in Denmark: A disappointing journey. Eur J Pain 2017; 21:1516-1527. [PMID: 28481052 DOI: 10.1002/ejp.1053] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Longitudinal population-based studies of long-term opioid therapy (L-TOT) in chronic non-cancer pain (CNCP) patients are sparse. Our study investigated incidence and predictors for initiating L-TOT and changes in self-rated health, pain interference and physical activities in long-term opioid users. METHODS Data were obtained from the national representative Danish Health and Morbidity Surveys and The Danish National Prescription Registry. Respondents with no dispensed opioids the year before the survey were followed from 2000 and from 2005 until the end of 2012 (n = 12,145). A nationally representative subsample of individuals (n = 2015) completed the self-administered questionnaire in both 2000 and 2013. Collected information included chronic pain (≥6 months), health behaviour, self-rated health, pain interference with work activities and physical activities. Long-term users were defined as those who were dispensed at least one opioid prescription in six separate months within a year. RESULTS The incidence of L-TOT was substantially higher in CNCP patients at baseline than in others (9/1000 vs. 2/1000 person-years). Smoking behaviour and dispensed benzodiazepines were significantly associated with initiation of L-TOT in individuals with CNCP at baseline. During follow-up, L-TOT in CNCP patients increased the likelihood of negative changes in pain interference with work (OR 9.2; 95% CI 1.9-43.6) and in moderate activities (OR 3.7; 95% CI 1.1-12.6). The analysis of all individuals indicated a dose-response relationship between longer treatment duration and the risk of experiencing negative changes. CONCLUSIONS Individuals on L-TOT seemed not to achieve the key goals of opioid therapy: pain relief, improved quality of life and functional capacity. SIGNIFICANCE Long-term opioid therapy does not seem to provide pain relief, improvement in HRQOL and physical capacity in CNCP patients in a general population.
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Affiliation(s)
- H Birke
- Department of Oncology, Rigshospitalet Copenhagen University Hospital, Denmark
| | - O Ekholm
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - P Sjøgren
- Department of Oncology, Rigshospitalet Copenhagen University Hospital, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences University of Copenhagen, Denmark
| | - G P Kurita
- Department of Oncology, Rigshospitalet Copenhagen University Hospital, Denmark.,Multidisciplinary Pain Centre, Rigshospitalet Copenhagen University Hospital, Denmark
| | - J Højsted
- Multidisciplinary Pain Centre, Rigshospitalet Copenhagen University Hospital, Denmark
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Foy R, Leaman B, McCrorie C, Petty D, House A, Bennett M, Carder P, Faulkner S, Glidewell L, West R. Prescribed opioids in primary care: cross-sectional and longitudinal analyses of influence of patient and practice characteristics. BMJ Open 2016; 6:e010276. [PMID: 27178970 PMCID: PMC4874107 DOI: 10.1136/bmjopen-2015-010276] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To examine trends in opioid prescribing in primary care, identify patient and general practice characteristics associated with long-term and stronger opioid prescribing, and identify associations with changes in opioid prescribing. DESIGN Trend, cross-sectional and longitudinal analyses of routinely recorded patient data. SETTING 111 primary care practices in Leeds and Bradford, UK. PARTICIPANTS We observed 471 828 patient-years in which all patients represented had at least 1 opioid prescription between April 2005 and March 2012. A cross-sectional analysis included 99 847 patients prescribed opioids between April 2011 and March 2012. A longitudinal analysis included 49 065 patient-years between April 2008 and March 2012. We excluded patients with cancer or treated for substance misuse. MAIN OUTCOME MEASURES Long-term opioid prescribing (4 or more prescriptions within 12 months), stronger opioid prescribing and stepping up to or down from stronger opioids. RESULTS Opioid prescribing in the adult population almost doubled for weaker opioids over 2005-2012 and rose over sixfold for stronger opioids. There was marked variation among general practices in the odds of patients stepping up to stronger opioids compared with those not stepping up (range 0.31-3.36), unexplained by practice-level variables. Stepping up to stronger opioids was most strongly associated with being underweight (adjusted OR 3.26, 1.49 to 7.17), increasing polypharmacy (4.15, 3.26 to 5.29 for 10 or more repeat prescriptions), increasing numbers of primary care appointments (3.04, 2.48 to 3.73 for over 12 appointments in the year) and referrals to specialist pain services (5.17, 4.37 to 6.12). Compared with women under 50 years, men under 50 were less likely to step down once prescribed stronger opioids (0.53, 0.37 to 0.75). CONCLUSIONS While clinicians should be alert to patients at risk of escalated opioid prescribing, much prescribing variation may be attributable to clinical behaviour. Effective strategies targeting clinicians and patients are needed to curb rising prescribing, especially of stronger opioids.
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Affiliation(s)
- Robbie Foy
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Ben Leaman
- Calderdale Metropolitan Borough Council, Halifax, UK
| | - Carolyn McCrorie
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Duncan Petty
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Allan House
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Michael Bennett
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Paul Carder
- Yorkshire & Humber Commissioning Support Unit, Bradford, UK
| | | | - Liz Glidewell
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Robert West
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Birke H, Kurita GP, Sjøgren P, Højsted J, Simonsen MK, Juel K, Ekholm O. Chronic non-cancer pain and the epidemic prescription of opioids in the Danish population: trends from 2000 to 2013. Acta Anaesthesiol Scand 2016; 60:623-33. [PMID: 26861026 DOI: 10.1111/aas.12700] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 11/20/2015] [Accepted: 12/18/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND Chronic pain has serious consequences for individuals and society. In addition, opioid prescription for chronic non-cancer pain (CNCP) has become more frequent. This study aims to examine the trends regarding the prevalence of CNCP, dispensed opioids, and concurrent use of benzodiazepine (BZD)/BZD-related drugs in the Danish population. METHODS Data from the cross-sectional national representative Danish Health and Morbidity Surveys (2000, 2005, 2010, and 2013) were combined with The Danish National Prescription Registry at an individual level. The study populations varied between 5000 and 13,000 individuals ≥16 years (response rates: 51-63%). Respondents completed a self-administered questionnaire, which included the analyzed items on identification of chronic pain (≥6 months). RESULTS From 2000 to 2013, the prevalence of CNCP increased and subsequently the annual prevalence of opioid use from 4.1% to 5.7% among CNCP individuals. Higher CNCP prevalence was related to female gender, no cohabitation partner, short education, non-Western origin, and overweight/obesity. In addition, women with CNCP, especially >65 years, became more frequent users of opioids and used higher doses than men. Concurrent use of BZD/BZD-related drugs decreased (13%) from 2010 to 2013, still one-third of long-term opioid user were co-medicated with these drugs. CONCLUSIONS The use of opioids has increased in Denmark, especially among elderly women. The concurrent use of BZD/BZD-related drugs has decreased from 2010 to 2013, but still one-third of long-term opioid users were co-medicated.
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Affiliation(s)
- H. Birke
- Department of Oncology; Rigshospitalet; Copenhagen Denmark
| | - G. P. Kurita
- Department of Oncology; Rigshospitalet Copenhagen University Hospital; Copenhagen Denmark
| | - P. Sjøgren
- Department of Oncology; Rigshospitalet Copenhagen University Hospital; Copenhagen Denmark
| | - J. Højsted
- Multidisciplinary Pain Centre; Rigshospitalet Copenhagen University Hospital; Copenhagen Denmark
| | - M. K. Simonsen
- Finsencenter; Rigshospitalet Copenhagen University Hospital; Copenhagen Denmark
| | - K. Juel
- National Institute of Public Health; University of Southern Denmark; Copenhagen Denmark
| | - O. Ekholm
- National Institute of Public Health; University of Southern Denmark; Copenhagen Denmark
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45
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Samuelsen PJ, Svendsen K, Wilsgaard T, Stubhaug A, Nielsen CS, Eggen AE. Persistent analgesic use and the association with chronic pain and other risk factors in the population-a longitudinal study from the Tromsø Study and the Norwegian Prescription Database. Eur J Clin Pharmacol 2016; 72:977-85. [PMID: 27071993 DOI: 10.1007/s00228-016-2056-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 03/31/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE Analgesics are commonly used drugs. The long-term effectiveness is mostly unproven, while the risk of several serious adverse effects is well established. We aimed to estimate the prevalence and incidence of persistent analgesic use and the association with chronic pain and sociodemographic and comorbid risk factors. METHODS The Tromsø Study is an epidemiological, prospective study of health and diseases. We linked the sixth wave (Tromsø 6, 2007-08, n = 12,981) with the Norwegian Prescription Database (NorPD, 2004-13). Persistent analgesic use was defined as the use of analgesics, i.e., either non-steroidal anti-inflammatory drugs, opioids or paracetamol, for ≥90 days with proportion-of-days-covered ≥40 %. The study design provided both cross-sectional and longitudinal data; a cohort of 11,905 persons was followed for 4.5 years. RESULTS The prevalence of persistent analgesic use was 4 % in general and 10 % among those reporting chronic pain. The incidence rate of persistent analgesic use was 21 per 1000 person-years in general. Baseline chronic pain doubled the risk of incident persistent analgesic use (HR = 2.05, 95 % CI 1.80-2.33). The risk increased with increasing chronic pain severity, as measured by chronic pain duration, frequency, intensity, and number of body locations. Sociodemographic risk factors were older age, female sex, lower education, and most likely lower physical activity. Psychological distress was not a statistical significant risk factor. CONCLUSIONS This study showed a relatively low prevalence of persistent analgesic use and that the majority of persons reporting chronic pain do not use analgesics persistently.
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Affiliation(s)
- Per-Jostein Samuelsen
- Regional Medicines Information and Pharmacovigilance Center (RELIS), University Hospital of North Norway, P.O. Box 79, N-9038, Tromsø, Norway. .,Department of Community Medicine, UiT-The Arctic University of Norway, Tromsø, Norway.
| | | | - Tom Wilsgaard
- Department of Community Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Audun Stubhaug
- Department of Pain Management and Research, Division of Emergencies and Intensive Care, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Christopher Sivert Nielsen
- Department of Pain Management and Research, Division of Emergencies and Intensive Care, Oslo University Hospital, Oslo, Norway.,Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Anne Elise Eggen
- Department of Community Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
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46
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Turner JA, Shortreed SM, Saunders KW, LeResche L, Von Korff M. Association of levels of opioid use with pain and activity interference among patients initiating chronic opioid therapy: a longitudinal study. Pain 2016; 157:849-857. [PMID: 26785321 PMCID: PMC4939796 DOI: 10.1097/j.pain.0000000000000452] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Little is known about long-term pain and function outcomes among patients with chronic noncancer pain initiating chronic opioid therapy (COT). In the Middle-Aged/Seniors Chronic Opioid Therapy study of patients identified through electronic pharmacy records as initiating COT for chronic noncancer pain, we examined the relationships between level of opioid use (over the 120 days before outcome assessment) and pain and activity interference outcomes at 4- and 12-month follow-ups. Patients aged 45+ years (N = 1477) completed a baseline interview; 1311 and 1157 of these comprised the 4- and 12-month analysis samples, respectively. Opioid use was classified based on self-report and electronic pharmacy records for the 120 days before the 4- and 12-month outcome assessments. Controlling for patient characteristics that predict sustained COT and pain outcomes, patients who had used opioids minimally or not at all, compared with those with intermittent/lower-dose and regular/higher-dose opioid use, had better pain intensity and activity interference outcomes. Adjusted mean (95% confidence interval) pain intensity (0-10 scale) at 12 months was 4.91 (4.68-5.13) for the minimal/no use group and 5.71 (5.50-5.92) and 5.72 (5.51-5.93) for the intermittent/lower-dose and regular/higher-dose groups, respectively. A similar pattern was observed for pain intensity at 4 months and for activity interference at both time points. Better outcomes in the minimal/no use group could reflect pain improvement leading to opioid discontinuation. The similarity in outcomes of regular/higher-dose and intermittent/lower-dose opioid users suggests that intermittent and/or lower-dose use vs higher-dose use may confer risk reduction without reducing benefits.
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Affiliation(s)
- Judith A. Turner
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Susan M. Shortreed
- Group Health Research Institute, Seattle, Washington, USA
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | | | - Linda LeResche
- Department of Oral Medicine, University of Washington, Seattle, Washington, USA
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47
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Häuser W, Petzke F, Radbruch L, Tölle TR. The opioid epidemic and the long-term opioid therapy for chronic noncancer pain revisited: a transatlantic perspective. Pain Manag 2016; 6:249-63. [PMID: 26988312 DOI: 10.2217/pmt.16.5] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The rise of opioid prescriptions and associated deaths ('opioid epidemic') in North America has evoked worldwide discussions on the long-term efficacy and safety of long-term opioid therapy (LtOT) for chronic noncancer pain (CNCP). We discuss if the opioid epidemic is a real worldwide or a more North American phenomenon. We consider reasons of the opioid epidemic. We highlight differences in the appraisal of the evidence of recent systematic reviews on LtOT for CNCP of US and European authors. We discuss similarities and differences of recent North American and European guidelines on LtOT for chronic CNCP. We point out potential indications and contraindications of LtOT in CNCP syndromes.
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Affiliation(s)
- Winfried Häuser
- Internal Medicine 1, Klinikum Saarbrücken, Winterberg 1, D-66119 Saarbrücken, Germany.,Department of Psychosomatic Medicine & Psychotherapy, Technische Universität München, Ismaningerstraβe 22, D-81675 München, Germany
| | - Frank Petzke
- Day Clinic & Out Patient Department Pain Therapy, Universitätsmedizin Göttingen, D-37075 Göttingen, Germany
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Center of Palliative Care, Malteser Hospital Seliger Gerhard Bonn/Rhein-Sieg, D-53127 Bonn, Germany
| | - Thomas R Tölle
- Department of Neurology, Technische Universität München, Ismaningerstraβe 22, D-81675 München, Germany
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48
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Mellbye A, Karlstad Ø, Skurtveit S, Borchgrevink PC, Fredheim OMS. The duration and course of opioid therapy in patients with chronic non-malignant pain. Acta Anaesthesiol Scand 2016; 60:128-37. [PMID: 26242816 DOI: 10.1111/aas.12594] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 05/31/2015] [Accepted: 07/02/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND Prescription databases provide the opportunity for investigating opioid treatment and co-medication within large populations. So far, few studies have investigated the duration of opioid therapy, and large differences in discontinuation rates have been reported. METHODS Data from the Norwegian Prescription Database were used to follow the study population of all adult persistent opioid users with non-malignant pain in Norway in 2005 (n = 44,867) for 6 years. Persistent opioid use was defined as being dispensed ≥ 180 defined daily doses (DDD) or 4500 mg oral morphine equivalents (OMEQ) during a 365-day period. The study population was stratified according to previous opioid use into new persistent opioid users, without previous persistent opioid use, and previous low-dose or previous high-dose persistent opioid users, having earlier persistent opioid use and received less or more than 120 mg OMEQ/day in 2005, respectively. RESULTS Twenty-seven percent of new, 59% of previous low-dose, and 55% of previous high-dose users met the criteria of persistent use of opioids each year. Exactly, 22%, 11%, and 3% increased their cumulative yearly opioid dose by 200% or more during the study period. With 80% still being regular users of either drugs, 6 years later, long-term persistent opioid users were more likely to continue concomitant use of benzodiazepines or z-hypnotics than other users, CONCLUSION The findings confirm high discontinuation rates in patients receiving opioids for chronic non-malignant pain. However, a clinically significant number of patients increase their doses over 6 years and many patients combine long-term opioid treatment with benzodiazepines and z-hypnotics.
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Affiliation(s)
- A. Mellbye
- Department of Circulation and Medical Imaging; Pain and Palliation Research Group; Faculty of Medicine; Norwegian University of Science and Technology; Trondheim Norway
- National Competence Centre for Complex Symptom Disorders; St. Olav's University Hospital; Trondheim Norway
| | - Ø. Karlstad
- Department of Pharmacoepidemiology; Division of Epidemiology; Norwegian Institute of Public Health; Oslo Norway
| | - S. Skurtveit
- Norwegian Centre for Addiction Research; University of Oslo; Oslo Norway
- Department of Pharmacoepidemiology; Division of Epidemiology; Norwegian Institute of Public Health; Oslo Norway
| | - P. C. Borchgrevink
- Department of Circulation and Medical Imaging; Pain and Palliation Research Group; Faculty of Medicine; Norwegian University of Science and Technology; Trondheim Norway
- National Competence Centre for Complex Symptom Disorders; St. Olav's University Hospital; Trondheim Norway
| | - O. M. S. Fredheim
- Department of Circulation and Medical Imaging; Pain and Palliation Research Group; Faculty of Medicine; Norwegian University of Science and Technology; Trondheim Norway
- National Competence Centre for Complex Symptom Disorders; St. Olav's University Hospital; Trondheim Norway
- Centre of Palliative Medicine; Akershus University Hospital; Oslo Norway
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49
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Adverse Drug Effects and Preoperative Medication Factors Related to Perioperative Low-Dose Ketamine Infusions. Reg Anesth Pain Med 2016; 41:482-7. [DOI: 10.1097/aap.0000000000000416] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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50
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Hansen AB, Skurtveit S, Borchgrevink PC, Dale O, Romundstad PR, Mahic M, Fredheim OM. Consumption of and satisfaction with health care among opioid users with chronic non-malignant pain. Acta Anaesthesiol Scand 2015; 59:1355-66. [PMID: 26113028 DOI: 10.1111/aas.12568] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 04/21/2015] [Accepted: 05/11/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND Although persons with chronic pain are frequent users of the health care system, they report poor satisfaction with health care services. Participants with persistent opioid use in Nord-Trøndelag Health Study (HUNT)3 report severe pain in spite of treatment. The aim of the study was to test the hypothesis that subjects with persistent opioid use have both a higher consumption of health care services and a poorer satisfaction than the remaining subjects reporting chronic pain. METHODS This cross-sectional study was based on linkage of self-reported data from the substudy (10,238 were invited, 6927 met the inclusion criteria) of health care use in HUNT3; a population-based health survey during the years 2006-2008 and the complete national registers of the Norwegian Prescription Database and the Cancer Registry of Norway. Patients with chronic pain are stratified according to the level of opioid use as persistent users of opioids, intermittent users, and persons not using opioids. RESULTS Persons with chronic non-malignant pain reported a higher consumption of all health care services compared to the control group. Consumption of health care services increased with increasing level of opioid use. Persons with persistent opioid use were highly satisfied with all health care services, although less satisfied than persons without chronic pain. CONCLUSIONS Combined with previous findings of high levels of pain in spite of opioid treatment, the present findings indicate that symptomatic relief is not a prerequisite for patient satisfaction. The study shows higher patient satisfaction compared to previous studies.
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Affiliation(s)
- A. B. Hansen
- Department of Circulation and Medical Imaging; Faculty of Medicine; Norwegian University of Science and Technology; Trondheim Norway
| | - S. Skurtveit
- Department of Pharmacoepidemiology; Division of Epidemiology; The Norwegian Institute of Public Health; Oslo Norway
- Norwegian Centre for Addiction Research; University of Oslo; Oslo Norway
| | - P. C. Borchgrevink
- Department of Circulation and Medical Imaging; Faculty of Medicine; Norwegian University of Science and Technology; Trondheim Norway
- National Competence Centre for Complex Symptom Disorders; Department of Pain and Complex Disorders; St. Olav University Hospital; Trondheim Norway
| | - O. Dale
- Department of Circulation and Medical Imaging; Faculty of Medicine; Norwegian University of Science and Technology; Trondheim Norway
- Department of Emergency Medicine; St. Olav University Hospital; Trondheim Norway
| | - P. R. Romundstad
- Department of Public Health and General Practice; Faculty of Medicine; Norwegian University of Science and Technology; Trondheim Norway
| | - M. Mahic
- Department of Pharmacoepidemiology; Division of Epidemiology; The Norwegian Institute of Public Health; Oslo Norway
| | - O. M. Fredheim
- Department of Circulation and Medical Imaging; Faculty of Medicine; Norwegian University of Science and Technology; Trondheim Norway
- National Competence Centre for Complex Symptom Disorders; Department of Pain and Complex Disorders; St. Olav University Hospital; Trondheim Norway
- Centre of Palliative Care; Surgical Division; Akershus University Hospital; Nordbyhagen Norway
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