Pain Medication Beliefs and Medication Misuse in Chronic Pain

Schieffer, Beatrix M.; Pham, Quyhn; Labus, Jennifer; Baria, Ariel; Van Vort, Walter; Davis, Philip; Davis, Frederick; Naliboff, Bruce D.

doi:10.1016/j.jpain.2005.04.004

« Previous Next »The Journal of Pain
Volume 6, Issue 9 , Pages 620-629, September 2005

Pain Medication Beliefs and Medication Misuse in Chronic Pain

Beatrix M. Schieffer
- Veteran’s Administration Greater Los Angles Healthcare System, Los Angeles, California
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California
Quyhn Pham
- Veteran’s Administration Greater Los Angles Healthcare System, Los Angeles, California
Jennifer Labus
- Center for Neurovisceral Sciences & Women’s Health
Ariel Baria
- Veteran’s Administration Greater Los Angles Healthcare System, Los Angeles, California
- Department of Medicine David Geffen School of Medicine at UCLA, Los Angeles, California
Walter Van Vort
- Veteran’s Administration Greater Los Angles Healthcare System, Los Angeles, California
Philip Davis
- Veteran’s Administration Greater Los Angles Healthcare System, Los Angeles, California
Frederick Davis
- Veteran’s Administration Greater Los Angles Healthcare System, Los Angeles, California
Bruce D. Naliboff
- Veteran’s Administration Greater Los Angles Healthcare System, Los Angeles, California
- Center for Neurovisceral Sciences & Women’s Health
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California
- Address reprint requests to Bruce D. Naliboff, PhD, Center for Neurovisceral Sciences & Women’s Health, VAGLAHS, Bldg. 115, Rm. 223, 11301 Wilshire Boulevard, Los Angeles, CA 90073

Received 14 January 2005; received in revised form 11 April 2005; accepted 15 April 2005.

Abstract

This study assessed the influence of medication beliefs, symptom severity, disability, mood, and psychiatric history on opiate medication misuse behaviors in 288 chronic pain patients. Data were gathered by questionnaires and systematic reviews of electronic medical records. The results demonstrate that patients with a history of substance abuse, compared to those without, showed greater medication misuse despite similar dosages and self-rated opiate effectiveness. Misusers believed more strongly in the potential for opiate addiction and that they required higher doses than others, but also had greater belief in opiate effectiveness and the importance of free access. Although both anxiety and substance abuse history are related to medication misuse, a multivariate analysis indicated that these factors can be seen as mediated by medication beliefs. These data suggest important roles for historical, affective, and cognitive variables in understanding medication misuse. Patients with a history of substance abuse report stronger beliefs in opiate effectiveness while simultaneously showing awareness of their addiction potential. Providers may help patients by addressing these issues prior to prescribing opiates.

Perspective

History of substance abuse is associated with increased opiate medication misuse independent of differences in reported opiate effectiveness. Self-attributions regarding opiate treatment related to need for higher doses, dose control, and addiction potential, may be important mediators of this relationship and interact with anxiety to produce heightened risk of opiate misuse.

Key words: Chronic pain , opiates , beliefs , mood , substance abuse , anxiety