Characteristics of patients receiving long-term opioid therapy for chronic noncancer pain: a cross-sectional survey of patients attending the Pain Management Centre at Hamilton General Hospital, Hamilton, Ontario

Opioid consumption has increased worldwide, which carries the risk of opioid use disorder (OUD). However, the literature on OUD and opioid-related chemical coping (OrCC) in chronic noncancer pain (CNCP) is heterogeneous, with most studies conducted in the United States. We performed a multicenter, observational, cross-sectional study to address OrCC in long-term opioid therapy (LtOT) for CNCP in South Korea. The objectives were to determine the frequency and predictors of OrCC. We included 258 patients. Among them, fifty-five (21%) patients showed OrCC. The sample had high pain catastrophizing (≥30 points; 66%), moderate-severe insomnia (≥15 points; 63%), low resilience (68 points), and high suicidal ideation (67%). OrCC patients had greater pain interference (85.18% vs. 58.28%, p = 0.017) and lower satisfaction with the LtOT (56.4% vs. 78.3%, p = 0.002). In multivariable analysis, alcohol abuse (OR = 6.84, p = 0.001), prescription drugs abuse (OR = 19.32, p = 0.016), functional pain (OR = 12.96, p < 0.001), head and neck pain (OR = 2.48, p = 0.039), MEDD (morphine equivalent daily dose) ≥ 200 mg/day (OR = 3.48, p = 0.006), and ongoing litigation (OR = 2.33, p = 0.047) were significant predictors of OrCC. In conclusion, the break-out of OrCC in CNCP in South Korea was comparable to those in countries with high opioid consumption, such as the United States, regardless of the country’s opioid consumption rate.

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Gender Differences in Depression and Sex Hormones among Patients Receiving Long-Term Opioid Treatment for Chronic Noncancer Pain in Taiwan—A Multicenter Cross-Sectional Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18157837 ◽

2021 ◽

Vol 18 (15) ◽

pp. 7837

Author(s):

Shung-Tai Ho ◽

Tso-Chou Lin ◽

Chun-Chang Yeh ◽

Kuang-I Cheng ◽

Wei-Zen Sun ◽

...

Keyword(s):

Sexual Function ◽

Sex Hormones ◽

Sex Hormone ◽

Cross Sectional ◽

Chronic Noncancer Pain ◽

Depression Diagnosis ◽

Opioid Treatment ◽

Hormone Levels ◽

Noncancer Pain

Background: Long-term use of opioids for chronic noncancer pain is associated with sex hormone disturbances. The interferences with sex hormones, sexual function, and depression were investigated in patients with chronic noncancer pain. Methods: A cross-sectional multicenter survey was conducted on 170 officially registered outpatients receiving long-term opioid treatment in nine medical centers in Taiwan between October 2018 and July 2019. Serum sex hormone levels were examined after the collection of self-administered questionnaires containing the Taiwanese version of the Brief Pain Inventory, depressive status, and sexual function interference. Results: Among 117 (68.8%) questionnaire responses from 170 enrolled outpatients, 38 women and 62 men completed the sex hormone tests, among whom only 23 (23%) had previously received blood hormone tests. Low serum total testosterone levels were detected in 34 (89.5%) women (<30 ng/dL) and 31 (50%) men (<300 ng/dL). Over 60% of women and men reported reduced sexual desire and function despite a nearly 50% reduction in pain intensity and daily function interference over the previous week after opioid treatment. Women generally had higher risks of a depression diagnosis (p = 0.034) and severe depressive symptoms (p = 0.003) and nonsignificantly lower opioid treatment duration (median 81 vs. 120 months) and morphine milligram equivalent (median 134 vs. 165 mg/day) compared with men. Conclusions: This survey demonstrated the high prevalence of depression diagnosis, low sex hormone levels, and reduced sexual function among Taiwanese patients with chronic noncancer pain receiving prolonged opioid therapy. Regular hypogonadal screenings are recommended for further management.

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Perceptions and Impact of the 2017 Canadian Guideline for Opioid Therapy and Chronic Noncancer Pain: A Cross-Sectional Study of Canadian Physicians

Pain Research and Management ◽

10.1155/2020/8380171 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Jason W. Busse ◽

Joyce Douglas ◽

Tara S. Chauhan ◽

Bilal Kobeissi ◽

Jeff Blackmer

Keyword(s):

Online Survey ◽

Preliminary Evidence ◽

Opioid Therapy ◽

Cross Sectional Study ◽

High Dose ◽

Cross Sectional ◽

Chronic Noncancer Pain ◽

Canadian Guideline ◽

Opioid Tapering ◽

Noncancer Pain

Background. Physician adherence to guideline recommendations for the use of opioids to manage chronic pain is often limited. Objective. In February 2018, we administered a 28-item online survey to explore perceptions of the 2017 Canadian guideline for opioid therapy and chronic noncancer pain and if physicians had altered practices in response to recommendations. Results. We invited 34,322 Canadian physicians to complete our survey, and 1,128 responded for a response rate of 3%; 687 respondents indicated they prescribed opioids for noncancer pain and answered survey questions about the guideline and their practice. Almost all were aware of the guideline, 94% had read the document, and 89% endorsed the clarity as good or excellent. The majority (86%) felt the guideline was feasible to implement, but 66% highlighted resistance by patients, and 63% the lack of access to effective nonopioid treatment as barriers. Thirty-six percent of respondents mistakenly believed the guideline recommended mandatory tapering for patients using high-dose opioid therapy (≥90 mg morphine equivalent per day), and 58% felt they would benefit from support for opioid tapering. Seventy percent of respondents had changed practices to align with guideline recommendations, with 51% engaging some high-dose patients in opioid tapering and 43% reducing the number of new opioid starts. Conclusion. There was high awareness of the 2017 Canadian opioid guideline among respondents, and preliminary evidence that recommendations have changed practice to better align with the evidence. Ongoing education is required to avoid the misunderstanding that opioid tapering is mandatory, and research to identify effective strategies to manage chronic noncancer pain is urgently needed.

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Long-term opioid therapy for chronic noncancer pain: second update of the German guidelines

PAIN Reports ◽

10.1097/pr9.0000000000000840 ◽

2020 ◽

Vol 5 (5) ◽

pp. e840

Author(s):

Frank Petzke ◽

Frietjof Bock ◽

Michael Hüppe ◽

Monika Nothacker ◽

Heike Norda ◽

...

Keyword(s):

Opioid Therapy ◽

Chronic Noncancer Pain ◽

Noncancer Pain

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Guideline-recommended vs high-dose long-term opioid therapy for chronic noncancer pain is associated with better health outcomes

Pain ◽

10.1097/j.pain.0000000000001067 ◽

2018 ◽

Vol 159 (1) ◽

pp. 85-91 ◽

Cited By ~ 15

Author(s):

Winfried Häuser ◽

Tino Schubert ◽

Norbert Scherbaum ◽

Thomas Tölle

Keyword(s):

Health Outcomes ◽

Opioid Therapy ◽

High Dose ◽

Chronic Noncancer Pain ◽

Noncancer Pain

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Changes in pain intensity after discontinuation of long-term opioid therapy for chronic noncancer pain

Pain ◽

10.1097/j.pain.0000000000001315 ◽

2018 ◽

Vol 159 (10) ◽

pp. 2097-2104 ◽

Cited By ~ 13

Author(s):

Sterling McPherson ◽

Crystal Lederhos Smith ◽

Steven K. Dobscha ◽

Benjamin J. Morasco ◽

Michael I. Demidenko ◽

...

Keyword(s):

Pain Intensity ◽

Opioid Therapy ◽

Chronic Noncancer Pain ◽

Noncancer Pain

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Opioid Misuse and Addiction Among Patients With Chronic Pain

Pain Care Essentials ◽

10.1093/med/9780199768912.003.0021 ◽

2019 ◽

pp. 339-354

Author(s):

Marc O. Martel ◽

Robert N. Jamison

Keyword(s):

Chronic Pain ◽

Opioid Therapy ◽

Screening Tools ◽

Prescription Opioid ◽

Opioid Misuse ◽

Chronic Noncancer Pain ◽

Medication Misuse ◽

Opioid Medications ◽

Noncancer Pain

Chapter 20 provides an introduction to understanding the prevalence and risk factors as well as screening tools for assessing opioid misuse and addiction in patients with chronic pain. In the era of the opioid epidemic in North America and beyond, the use of prescription opioid medications to help improve function in chronic noncancer pain is frequently debated. Out of fear of iatrogenic addiction, litigation, and/or potential medication misuse, some clinicians are refusing to prescribe opioids for chronic pain. Evidence indicates that rates of opioid misuse and addiction are fairly high among chronic pain patients prescribed long-term opioid therapy, but there is consensus that opioids can be safe and effective for carefully selected and monitored patients.

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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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