Factors influencing nurses’ knowledge and attitudes toward patients in chronic pain with opioid use disorder: A literature review

Background and objective: Chronic pain is a common symptom among patients worldwide. This issue leads health care professionals to manage patients’ chronic pain by using opioids. However, some patients tend to abuse these medications and develop opioid use disorder. The aim of the study was to identify and explore factors that influence nurses’ knowledge and attitudes toward patients in chronic pain with opioid use disorder.Methods: A literature review was conducted. CINAHL, Medline, and PsychINFO databases were used to search for relevant articles. A total of 12 articles that met the inclusion criteria were retrieved.Results: This literature review showed several factors that influence nurses’ knowledge and attitudes. These factors were nurses’ education, role support, demographic factors, nurses’ experiences, and nurses’ beliefs and culture.Conclusions: The findings of this literature review will inform the development of an educational program to promote nurses’ knowledge and attitudes toward patients in chronic pain with opioid use disorder.

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Development and validation of the Capacity to Treat Chronic Pain and Opioid Use Disorder (CAP-POD) questionnaire

Implementation Research and Practice ◽

10.1177/2633489520948859 ◽

2020 ◽

Vol 1 ◽

pp. 263348952094885

Author(s):

Allyson L Varley ◽

Burel R Goodin ◽

Heith Copes ◽

Stefan G Kertesz ◽

Kevin Fontaine ◽

...

Keyword(s):

Chronic Pain ◽

Best Practice ◽

Primary Care Providers ◽

Opioid Use Disorder ◽

Care Providers ◽

Opioid Use ◽

High Quality Research ◽

Practice Recommendations ◽

Factors Influencing ◽

Item Questionnaire

Background: Patients with co-occurring chronic pain and opioid use disorder (OUD) have unique needs that may present challenges for clinicians and health care systems. Primary care providers’ (PCPs) capacity to deliver high quality, research-informed care for this population is unknown. The objective of this study was to develop and test a questionnaire of factors influencing PCP capacity to treat co-occurring chronic pain and OUD. Methods: Capacity to Treat Co-Occurring Chronic Pain and Opioid Use Disorder (CAP-POD) questionnaire items were developed over a 2-year process including literature review, semi-structured interviews, and expert panel review. In 2018, a national sample of 509 PCPs was recruited through email to complete a questionnaire including the initial 44-item draft CAP-POD questionnaire. CAP-POD items were analyzed for dimensionality, inter-item reliability, and construct validity. Results: Principal component analysis resulted in a 22-item questionnaire. Twelve more items were removed for parsimony, resulting in a final 10-item questionnaire with the following 4 scales: (1) Motivation to Treat patients with chronic pain and OUD (α = .87), (2) Trust in Evidence (α = .87), (3) Assessing Risk (α = .82), and (4) Patient Access to therapies (α = .79). These scales were associated with evidence-based practice attitudes, knowledge of pain management, and self-reported behavioral adherence to best practice recommendations. Conclusion: We developed a brief, 10-item questionnaire that assesses factors influencing the capacity of PCPs to implement best practice recommendations for the treatment of co-occurring chronic pain and OUD. The questionnaire demonstrated good reliability and initial evidence of validity, and may prove useful in future research as well as clinical settings. Plain language abstract Patients with co-occurring chronic pain and opioid use disorder (OUD) have unique needs that may present challenges for clinicians and health care systems. Primary care providers’ (PCPs) ability to deliver high quality, research-informed care for this population is unknown. There are no validated instruments to assess factors influencing PCP capacity to implement best practices for treating these patients. The objective of this study was to develop and test a questionnaire of factors influencing PCP capacity to treat co-occurring chronic pain and OUD. We recruited 509 PCPs to participate in an online questionnaire that included 44 potential items that assess PCP capacity. Analyses resulted in a 10-item questionnaire that assesses factors influencing capacity to implement best practice recommendations for the treatment of co-occurring chronic pain and OUD. PCPs reported moderately high confidence in the strength and quality of evidence for best practices, and in their ability to identify patients at risk. However, PCPs reported low motivation to treat co-occurring chronic pain and OUD, and perceived patients’ access to relevant services as suboptimal, highlighting two areas that should be targeted with tailored implementation strategies. The 10-item Capacity to Treat Chronic Pain and Opioid Use Disorder (CAP-POD) questionnaire can be used for two purposes: (1) to assess factors influencing PCP capacity before implementation and identify areas that may require improvement for implementation and (2) to evaluate implementation interventions aimed at increasing PCP capacity to treat this population.

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Comorbid chronic pain and opioid use disorder: literature review and potential treatment innovations

International Review of Psychiatry ◽

10.1080/09540261.2018.1514369 ◽

2018 ◽

Vol 30 (5) ◽

pp. 136-146 ◽

Cited By ~ 16

Author(s):

Traci J. Speed ◽

Vinay Parekh ◽

William Coe ◽

Denis Antoine

Keyword(s):

Chronic Pain ◽

Literature Review ◽

Opioid Use Disorder ◽

Potential Treatment ◽

Opioid Use

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The Impact of Chronic Pain on Opioid Use Disorder Treatment Outcomes

Current Addiction Reports ◽

10.1007/s40429-020-00352-6 ◽

2021 ◽

Author(s):

R. Ross MacLean ◽

Suzanne Spinola ◽

Gabriella Garcia-Vassallo ◽

Mehmet Sofuoglu

Keyword(s):

Chronic Pain ◽

Treatment Outcomes ◽

Opioid Use Disorder ◽

Opioid Use ◽

Disorder Treatment ◽

The Impact

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Chronic pain in patients with opioid use disorder receiving methadone

Journal of the Neurological Sciences ◽

10.1016/j.jns.2017.08.482 ◽

2017 ◽

Vol 381 ◽

pp. 165

Author(s):

Z. Samaan ◽

B. Dennis ◽

M. Bawor ◽

M. Bhatt ◽

L. Zielinski ◽

...

Keyword(s):

Chronic Pain ◽

Opioid Use Disorder ◽

Opioid Use

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A pilot randomized clinical trial of mindfulness-oriented recovery enhancement as an adjunct to methadone treatment for people with opioid use disorder and chronic pain: Impact on illicit drug use, health, and well-being

Journal of Substance Abuse Treatment ◽

10.1016/j.jsat.2021.108468 ◽

2021 ◽

pp. 108468

Author(s):

Nina A. Cooperman ◽

Adam W. Hanley ◽

Anna Kline ◽

Eric L. Garland

Keyword(s):

Clinical Trial ◽

Chronic Pain ◽

Drug Use ◽

Randomized Clinical Trial ◽

Illicit Drug ◽

Methadone Treatment ◽

Well Being ◽

Opioid Use Disorder ◽

Opioid Use ◽

Health And Well Being

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An evaluation of the feasibility, acceptability, and preliminary efficacy of cognitive-behavioral therapy for opioid use disorder and chronic pain

Drug and Alcohol Dependence ◽

10.1016/j.drugalcdep.2018.10.015 ◽

2019 ◽

Vol 194 ◽

pp. 460-467 ◽

Cited By ~ 18

Author(s):

Declan T. Barry ◽

Mark Beitel ◽

Christopher J. Cutter ◽

David A. Fiellin ◽

Robert D. Kerns ◽

...

Keyword(s):

Chronic Pain ◽

Cognitive Behavioral Therapy ◽

Behavioral Therapy ◽

Opioid Use Disorder ◽

Cognitive Behavioral ◽

Opioid Use

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Mindfulness-Oriented Recovery Enhancement remediates anhedonia in chronic opioid use by enhancing neurophysiological responses during savoring of natural rewards

Psychological Medicine ◽

10.1017/s0033291721003834 ◽

2021 ◽

pp. 1-10

Author(s):

Eric L. Garland ◽

Spencer T. Fix ◽

Justin P. Hudak ◽

Edward M. Bernat ◽

Yoshio Nakamura ◽

...

Keyword(s):

Chronic Pain ◽

Skin Conductance Level ◽

Opioid Therapy ◽

Opioid Use Disorder ◽

Opioid Use ◽

Natural Reward ◽

Before And After ◽

Natural Rewards ◽

Chronic Opioid Use ◽

Opioid Users

Abstract Background Neuropsychopharmacologic effects of long-term opioid therapy (LTOT) in the context of chronic pain may result in subjective anhedonia coupled with decreased attention to natural rewards. Yet, there are no known efficacious treatments for anhedonia and reward deficits associated with chronic opioid use. Mindfulness-Oriented Recovery Enhancement (MORE), a novel behavioral intervention combining training in mindfulness with savoring of natural rewards, may hold promise for treating anhedonia in LTOT. Methods Veterans receiving LTOT (N = 63) for chronic pain were randomized to 8 weeks of MORE or a supportive group (SG) psychotherapy control. Before and after the 8-week treatment groups, we assessed the effects of MORE on the late positive potential (LPP) of the electroencephalogram and skin conductance level (SCL) during viewing and up-regulating responses (i.e. savoring) to natural reward cues. We then examined whether these neurophysiological effects were associated with reductions in subjective anhedonia by 4-month follow-up. Results Patients treated with MORE demonstrated significantly increased LPP and SCL to natural reward cues and greater decreases in subjective anhedonia relative to those in the SG. The effect of MORE on reducing anhedonia was statistically mediated by increases in LPP response during savoring. Conclusions MORE enhances motivated attention to natural reward cues among chronic pain patients on LTOT, as evidenced by increased electrocortical and sympathetic nervous system responses. Given neurophysiological evidence of clinical target engagement, MORE may be an efficacious treatment for anhedonia among chronic opioid users, people with chronic pain, and those at risk for opioid use disorder.

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0259 Shiftworkers are at Increased Risk of Developing Chronic Pain and Opioid Use Disorders: A Study of 116,000 UK Biobank Participants Over a Decade

SLEEP ◽

10.1093/sleep/zsaa056.257 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A98-A99

Author(s):

L Gao ◽

P Li ◽

L Cui ◽

Y Luo ◽

C Vetter ◽

...

Keyword(s):

Chronic Pain ◽

Bone Fractures ◽

Inflammatory Diseases ◽

Opioid Use Disorder ◽

Uk Biobank ◽

Opioid Use ◽

Logistic Regression Models ◽

Diagnostic Coding ◽

Increased Risk ◽

Opioid Use Disorders

Abstract Introduction In the current epidemic of opioid-related deaths, and widespread use of opioids to treat chronic pain, there is a pressing need to understand the underlying risk factors that contribute to such devastating conditions. Shiftwork has been associated with adverse health outcomes. We tested whether shiftwork during middle age is linked to the development of chronic pain and opioid misuse. Methods We studied 116,474 participants in active employment between 2006–2010 (mean age 57±8; range 37–71) from the UK Biobank, who have been followed for up to 10 years until 2017. We included participants who were free from all forms of self-reported pain, and were not taking opioid medications at baseline. Chronic pain and opioid use disorder diagnoses were determined using hospitalization records and diagnostic coding from ICD-10. Multivariate logistic regression models were performed to examine the associations of shiftwork status (yes/no) and nightshift frequency (none/occasional/permanent) and with incident chronic pain and/or opioid use disorder during follow-up. Models were adjusted for demographics, education, Townsend deprivation index, major confounders (BMI, diabetes, bone fractures/injuries, operations, peripheral vascular disease, joint/inflammatory diseases, cancer, standing/manual labor at work) and covariates (smoking, alcohol, high cholesterol, depression/anxiety, and cardiovascular diseases). Results In total, 190 (1.6/1,000) developed chronic pain or opioid use disorders. Shiftworkers (n=17,673) saw a 1.5-fold increased risk (OR 1.56, 95% CI: 1.08–2.24, p=0.01) relative to day workers. Within shiftworkers, those who reported occasional nightshift work (n=3,966) were most vulnerable (OR 1.57, 95% CI: 1.06–2.34, p=0.02). Results remained similar after adjusting for baseline sleep duration, chronotype and insomnia. Conclusion Shiftwork, and in particular rotating nightshift work is associated with increased risk for developing chronic pain and opioid use disorders. Replication is required to confirm the findings and to examine underlying mechanisms. Support This work was supported by NIH grants T32GM007592, RF1AG064312, and RF1AG059867.

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Predicting opioid use disorder in patients with chronic pain who present to the emergency department

Injury Prevention ◽

10.1136/injuryprev-2018-042723 ◽

2018 ◽

Vol 25 (5) ◽

pp. 386-391

Author(s):

Robert Andrew Gardner ◽

Kori L Brewer ◽

Dennis B Langston

Keyword(s):

Emergency Department ◽

Chronic Pain ◽

Opioid Therapy ◽

Opioid Use Disorder ◽

Small Sample ◽

Pain Medicine ◽

Dose Increase ◽

Emergency Physicians ◽

Opioid Use ◽

Prescription Monitoring

BackgroundEmergency department (ED) patients with chronic pain challenge providers to make quick and accurate assessments without an in-depth pain management consultation. Emergency physicians need reliable means to determine which patients may receive opioid therapy without exacerbating opioid use disorder (OUD).MethodsEighty-nine ED patients with a chief complaint of chronic pain were enrolled. Researchers administered questionnaires and reviewed medical and state prescription monitoring database information. Participants were classified as either OUD or non-OUD. Statistical analysis included a bivariate analysis comparing differences between groups and multivariate logistic regression evaluating ORs.ResultsThe 45 participants categorised as OUD had a higher proportion of documented or reported psychiatric diagnoses (p=0.049), preference of opioid treatment (p=0.005), current oxycodone prescription (p=0.043), borrowed pain medicine (p=0.004) and non-authorised dose increase (p<0.001). The state prescription monitoring database revealed the OUD group to have an increased number of opioid prescriptions (p=0.005) and pills (p=0.010). Participants who borrowed pain medicine and engaged in non-authorised dose increase were 5.2 (p=0.025, 95% CI 1.24 to 21.9) and 6.1 times (p=0.001, 95% CI 1.55 to 24.1) more likely to have OUD, respectively.LimitationsMajor limitations of our study include a small sample size, self-reported measures and convenience sample which may introduce selection bias.ConclusionPatients with chronic pain with OUD have distinguishable characteristics. Emergency physicians should consider such evidence-based variables prior to opioid therapy to ameliorate the opioid crisis and limit implicit bias.

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