Opioid Dosage Levels, Concurrent Risk Factors and Self-Perceptions among Chronic Pain, Opioid-Managed Individuals at Elevated Risk for Opioid Overdose

While current opioid prescribing guidelines highlight a dose-response relationship between therapeutic management and overdose risk, other concurrent risk factors have also been identified. However, there is little data in assessing the relationship between risk factor prevalence, associated provider communication, and subsequent perceptions of overdose risk among chronic pain, opioid-managed (CPOM) patients. An online questionnaire was distributed in June 2020 to a sample of CPOM individuals (n = 190) treated with an opioid prescription at or above 50 daily MME, or any dosage alongside benzodiazepines. CPOM individuals reported a mean daily MME of 470, with half (52.6%) receiving a concurrent benzodiazepine prescription. All patients reported past month alcohol use, and 67.4% indicated a risk-elevating diagnosed medical condition. In assessing provider communication, 41.6% reported no discussion focusing on the risks of one’s opioid therapy. Subsequently, 62.1% perceived themselves as having “no risk”, and 60.0% were “not at all concerned” (60.0%) about experiencing an opioid overdose. Organizational policies should focus on implementing consistent methods of patient education regarding overdose risk, as well as assessments of behaviors or characteristics that my increase an individual’s risk of opioid overdose. These policies should also include other forms of evidence-based overdose risk prevention such as co-prescriptions of naloxone.

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Patient Perspectives on Improving Patient-Provider Relationships and Provider Communication During Opioid Tapering

Journal of General Internal Medicine ◽

10.1007/s11606-021-07210-9 ◽

2022 ◽

Author(s):

Sarah Kosakowski ◽

Allyn Benintendi ◽

Pooja Lagisetty ◽

Marc R. Larochelle ◽

Amy S. B. Bohnert ◽

...

Keyword(s):

Chronic Pain ◽

Opioid Therapy ◽

Social Consequences ◽

Opioid Overdose ◽

Provider Communication ◽

Medical Systems ◽

Structured Interviews ◽

Patient Centered ◽

Adverse Experiences ◽

Quality And Outcomes

Abstract Background Efforts to reduce opioid overdose fatalities have resulted in tapering (i.e., reducing or discontinuing) opioid prescriptions despite a limited understanding of patients’ experiences. Objective To explore patients’ perspectives on opioid taper experiences to ultimately improve taper processes and outcomes. Design Qualitative study. Participants Patients on long-term opioid therapy for chronic pain who had undergone a reduction of opioid daily prescribed dosage of ≥50% in the past 2 years in two distinct medical systems and regions. Approach From 2019 to 2020, we conducted semi-structured interviews that were audio-recorded, transcribed, systematically coded, and analyzed to summarize the content and identify key themes regarding taper experiences overall and with particular attention to patient-provider relationships and provider communication during tapers. Key Results Participants (n=41) had lived with chronic pain for an average of 17.4 years (range, 3–36 years) and described generally adverse experiences with opioid tapers, the initiation of which was not always adequately justified or explained to them. Consequences of tapers ranged from minor to substantial and included withdrawal, mobility issues, emotional distress, exacerbated mental health symptoms, and feelings of social stigmatization for which adequate supports were typically unavailable. Narratives highlighted the consequential role of patient-provider relationships throughout taper experiences, with most participants describing significant interpersonal challenges including poor provider communication and limited patient engagement in decision making. A few participants identified qualities of providers, relationships, and communication that fostered more positive taper experiences and outcomes. Conclusions From patients’ perspectives, opioid tapers can produce significant physical, emotional, and social consequences, sometimes reducing trust and engagement in healthcare. Patient-provider relationships and communication influence patients’ perceptions of the quality and outcomes of opioid tapers. To improve patients’ experiences of opioid tapers, tapering plans should be based on individualized risk-benefit assessments and involve patient-centered approaches and improved provider communication.

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STUDY OF RELATIONSHIP OF PSYCHOSOCIAL FACTORS WITH SMOKING IN NORTHERN POPULATION

Wiadomości Lekarskie ◽

10.36740/wlek202103125 ◽

2021 ◽

Vol 74 (3) ◽

pp. 517-522

Author(s):

Natalia V. Borisova ◽

Sardana V. Markova ◽

Irina Sh. Malogulova

Keyword(s):

Risk Factors ◽

Marital Status ◽

Psychosocial Factors ◽

Abdominal Obesity ◽

Medical Condition ◽

Manual Labor ◽

Northern Population ◽

Level Of Education ◽

The People ◽

The Relationship

The aim: Of our study was to identify the relationship between the main risk factors for heart disease and social factors among northern population. Materials and methods: We polled 3092 native and non-native habitants of the Sakha Republic (Yakutia). The poll consists of several sections. It includes questions related to social, demographic and life record data, heredity, physical activity and unhealthy habits. Results: Among the people diagnosed with hypertension (HT), there are more smokers than among the people without this medical condition. On the contrary, in the group of people diagnosed with HT at the examination for taking blood pressure, there were fewer smokers than in the group, in which HT was not registered. Patients with CHD, Myocardial infarction (MI) in past medical history, cerebrovascular accident (CVA) and type 2 diabetes (T2D), are smokers to the same degree as the other group. This indicates that this category of the examined are exposed to the risk of cardiovascular aggravations. We determined a high spread of psychosocial risk factors for the examined respondents – the relationship between smoking, overweight, obesity, abdominal obesity and HT, and the level of education, marital status and labor specificity. The increase in the level of education is associated with fewer amounts of smokers among both non-native and native habitants. Overweight is more frequently observed for the people who are not single, have low level of education and are engaged in manual labor. In particular, it is applicable to native habitants. Conclusions: Abdominal obesity did not have any relationship with psychosocial factors for native habitants. However, in relation to non-native habitants, overweight, obesity, abdominal obesity and HT are associated with marital status (married) and with manual labor.

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Opioid Therapy for Chronic Noncancer Pain: Safe, Effective, Appropriate?

10.2310/fm.15027 ◽

2016 ◽

Author(s):

Joseph V. Pergolizzi Jr ◽

Robert B. Raffa ◽

Robert Taylor ◽

Jo Ann LeQuang

Keyword(s):

Risk Factors ◽

Chronic Pain ◽

Elderly Patients ◽

The United States ◽

Opioid Therapy ◽

Abuse Liability ◽

Opioid Abuse ◽

Individual Risk ◽

Chronic Noncancer Pain ◽

Routes Of Administration

In determining the appropriate role of opioids, two public health crises must be balanced: the opioid abuse epidemic and the “silent” crisis of unrelieved chronic pain. Opioids can be used safely and effectively in selected patients; however, clinicians must be aware of their abuse liability and individual risk factors for opioid misuse. A number of opioids are approved for use in the United States, and although there are class effects, there can be great variability among patients with regard to opioid response. In addition to the medication, prescribers must also determine the most appropriate dose and route of administration. Considerations must be made for special population, such as the renally impaired, those with hepatic dysfunction, and pediatric and elderly patients. Another factor is abuse-deterrent properties. Of particular interest as an opioid agent is buprenorphine, which is available in various routes of administration and because of its unique pharmacokinetics may be administered to renally compromised and elderly patients without dosing restrictions. Buprenorphine is also associated with a lower abuse liability than other opioids. Patients suffering moderate to severe pain syndromes should not be denied access to effective pain control, which in some cases may appropriately include opioid therapy. Key words: Buprenorphine, Chronic Pain, Opioid, Opioid Abuse, Opioid Prescribing, Risk Factors for Opioid Abuse

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Pain Catastrophizing Moderates Relationships between Pain Intensity and Opioid Prescription

Anesthesiology ◽

10.1097/aln.0000000000001656 ◽

2017 ◽

Vol 127 (1) ◽

pp. 136-146 ◽

Cited By ~ 21

Author(s):

Yasamin Sharifzadeh ◽

Ming-Chih Kao ◽

John A. Sturgeon ◽

Thomas J. Rico ◽

Sean Mackey ◽

...

Keyword(s):

Chronic Pain ◽

Pain Intensity ◽

Pain Treatment ◽

Pain Catastrophizing ◽

Tertiary Care ◽

Treatment Center ◽

Women Patients ◽

Opioid Prescription ◽

Men And Women ◽

The Relationship

Abstract Background Pain catastrophizing is a maladaptive response to pain that amplifies chronic pain intensity and distress. Few studies have examined how pain catastrophizing relates to opioid prescription in outpatients with chronic pain. Methods The authors conducted a retrospective observational study of the relationships between opioid prescription, pain intensity, and pain catastrophizing in 1,794 adults (1,129 women; 63%) presenting for new evaluation at a large tertiary care pain treatment center. Data were sourced primarily from an open-source, learning health system and pain registry and secondarily from manual review of electronic medical records. A binary opioid prescription variable (yes/no) constituted the dependent variable; independent variables were age, sex, pain intensity, pain catastrophizing, depression, and anxiety. Results Most patients were prescribed at least one opioid medication (57%; n = 1,020). A significant interaction and main effects of pain intensity and pain catastrophizing on opioid prescription were noted (P < 0.04). Additive modeling revealed sex differences in the relationship between pain catastrophizing, pain intensity, and opioid prescription, such that opioid prescription became more common at lower levels of pain catastrophizing for women than for men. Conclusions Results supported the conclusion that pain catastrophizing and sex moderate the relationship between pain intensity and opioid prescription. Although men and women patients had similar Pain Catastrophizing Scale scores, historically “subthreshold” levels of pain catastrophizing were significantly associated with opioid prescription only for women patients. These findings suggest that pain intensity and catastrophizing contribute to different patterns of opioid prescription for men and women patients, highlighting a potential need for examination and intervention in future studies.

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An Analysis of Primary Care Clinician Communication About Risk, Benefits, and Goals Related to Chronic Opioid Therapy

MDM Policy & Practice ◽

10.1177/2381468319892572 ◽

2019 ◽

Vol 4 (2) ◽

pp. 238146831989257

Author(s):

Elizabeth C. Danielson ◽

Olena Mazurenko ◽

Barbara T. Andraka-Christou ◽

Julie DiIulio ◽

Sarah M. Downs ◽

...

Keyword(s):

United States ◽

Primary Care ◽

Chronic Pain ◽

The United States ◽

Opioid Therapy ◽

Opioid Overdose ◽

Chronic Noncancer Pain ◽

Opioid Prescribing ◽

Limited Effectiveness ◽

Pain Care

Background. Safe opioid prescribing and effective pain care are particularly important issues in the United States, where decades of widespread opioid prescribing have contributed to high rates of opioid use disorder. Because of the importance of clinician-patient communication in effective pain care and recent initiatives to curb rising opioid overdose deaths, this study sought to understand how clinicians and patients communicate about the risks, benefits, and goals of opioid therapy during primary care visits. Methods. We recruited clinicians and patients from six primary care clinics across three health systems in the Midwest United States. We audio-recorded 30 unique patients currently receiving opioids for chronic noncancer pain from 12 clinicians. We systematically analyzed transcribed, clinic visits to identify emergent themes. Results. Twenty of the 30 patient participants were females. Several patients had multiple pain diagnoses, with the most common diagnoses being osteoarthritis ( n = 10), spondylosis ( n = 6), and low back pain ( n = 5). We identified five themes: 1) communication about individual-level and population-level risks, 2) communication about policies or clinical guidelines related to opioids, 3) communication about the limited effectiveness of opioids for chronic pain conditions, 4) communication about nonopioid therapies for chronic pain, and 5) communication about the goal of the opioid tapering. Conclusions. Clinicians discuss opioid-related risks in varying ways during patient visits, which may differentially affect patient experiences. Our findings may inform the development and use of more standardized approaches to discussing opioids during primary care visits.

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Opioid Therapy for Chronic Noncancer Pain: Safe, Effective, Appropriate?

10.2310/pm.15027 ◽

2016 ◽

Author(s):

Joseph V. Pergolizzi Jr ◽

Robert B. Raffa ◽

Robert Taylor ◽

Jo Ann LeQuang

Keyword(s):

Risk Factors ◽

Chronic Pain ◽

Elderly Patients ◽

The United States ◽

Opioid Therapy ◽

Abuse Liability ◽

Opioid Abuse ◽

Individual Risk ◽

Chronic Noncancer Pain ◽

Routes Of Administration

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Entertaining accurate treatment expectations while suffering from chronic pain: an exploration of treatment expectations and the relationship with patient- provider communication

BMC Health Services Research ◽

10.1186/s12913-018-3497-8 ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 2

Author(s):

Bianca Wiering ◽

Dolf de Boer ◽

Maarten Krol ◽

Hilda Wieberneit-Tolman ◽

Diana Delnoij

Keyword(s):

Chronic Pain ◽

Provider Communication ◽

Treatment Expectations ◽

Accurate Treatment ◽

Patient Provider Communication ◽

The Relationship

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A Two-Year Prospective Multicenter Study of Opioid Therapy for Chronic Noncancer Pain: Prescription Trends and Predictors

Pain Medicine ◽

10.1093/pm/pny275 ◽

2018 ◽

Vol 20 (11) ◽

pp. 2166-2178 ◽

Cited By ~ 1

Author(s):

Dalila R Veiga ◽

Liliane Mendonça ◽

Rute Sampaio ◽

José M Castro-Lopes ◽

Luís F Azevedo

Keyword(s):

Chronic Pain ◽

Clinical Outcomes ◽

Opioid Therapy ◽

Opioid Use ◽

Opioid Prescription ◽

Chronic Noncancer Pain ◽

Noncancer Pain ◽

Opioid Users

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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Individuals with Chronic Pain Who Misuse Prescription Opioids Report Sex-Based Differences in Pain and Opioid Withdrawal

Pain Medicine ◽

10.1093/pm/pny295 ◽

2019 ◽

Vol 20 (10) ◽

pp. 1942-1947 ◽

Cited By ~ 3

Author(s):

Andrew S Huhn ◽

D Andrew Tompkins ◽

Claudia M Campbell ◽

Kelly E Dunn

Keyword(s):

Chronic Pain ◽

Pain Catastrophizing ◽

Opioid Withdrawal ◽

Self Report ◽

Amazon Mechanical Turk ◽

Opiate Withdrawal ◽

Opioid Overdose ◽

Prescription Opioids ◽

Opioid Misuse ◽

The Relationship

Abstract Objective Individuals with chronic pain who misuse prescription opioids are at high risk for developing opioid use disorder and/or succumbing to opioid overdose. The current study conducted a survey to evaluate sex-based differences in pain catastrophizing, opioid withdrawal, and current pain in persons with co-occurring chronic pain and opioid misuse. We hypothesized that women with chronic pain who misused prescription opioids would self-report higher pain ratings compared with men and that the relationship between pain catastrophizing and self-reported current pain would be moderated by symptoms of opioid withdrawal in women only. Design Survey assessment of the relationship between pain and opioid misuse. Setting Online via Amazon Mechanical Turk. Participants Persons with ongoing chronic pain who also misused prescription opioids on one or more days in the last 30 days were eligible (N = 181). Methods Participants completed demographic and standardized assessments including the Brief Pain Inventory (BPI), Pain Catastrophizing Scale (PCS), and Subjective Opiate Withdrawal Scale (SOWS). Results Women reported higher levels of current (P < 0.001), average (P < 0.001), and worst (P = .002) pain in the last 24 hours compared with men. Women also endorsed higher scores on the PCS (P = 0.006) and marginally higher past-30-day SOWS ratings (P = 0.068) compared with men. SOWS ratings moderated the relationship between PCS and BPI Worst Pain in women (ΔR2 < 0.127, ΔF(1, 78) = 12.39, P = 0.001), but not in men (ΔR2 < 0.000, ΔF(1, 98) = 0.003, P = 0.954). Conclusions These data suggest a strong relationship between opioid withdrawal, pain catastrophizing, and the experience of pain in women with chronic pain who misuse opioids.

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