Abstract
This study examined the relative impact of pain relief and opioid side effects on
patients' and physicians' preferences for medication. An Internet survey was completed
by 618 patients (302 acute pain, 316 chronic pain) and 325 physicians (83 primary
care, 80 pain specialists, 41 oncologists, 40 general surgeons, 40 orthopedic surgeons,
20 rheumatologists, 21 neurologists). Respondents completed an Adaptive Conjoint Analysis
(ACA) exercise in which they indicated their relative preference for 20 pairs of hypothetical
opioid pain medications described by varying levels of pain relief and side-effect
incidence. Almost all patients (96% of chronic, 92% of acute) reported experiencing
at least 1 side effect while on opioid medication, but physician-estimated incidence
rates of most opioid side effects were much lower than those reported by patients.
Opioid side effects, rather than pain relief, explained the majority of variance for
medication preference for both patients (74% for chronic, 73% for acute) and treating
physicians (73% for chronic, 74% for acute) in this exercise. Nausea and vomiting
were major determinants of opioid medication preference, with each explaining as much
of the variance in preference as did pain relief (21% to 25%). Nausea and vomiting
were the most important side effects based on the amount of pain relief that respondents
were willing to give up for reducing the incidence of side effects. The importance
of side effects was confirmed in an open-ended question where 51% of patients and
58% of physicians identified side-effect reduction as an unmet need for pain medications.
Perspective
This study provided insights into patient and physician preferences of the risk and
benefit balance of opioid therapy. This information could improve understanding of
patient needs and facilitate the incorporation of patient preference into therapy
choice.
Key words
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Article info
Publication history
Published online: May 10, 2010
Accepted:
February 10,
2010
Received in revised form:
February 8,
2010
Received:
June 16,
2009
Footnotes
Supported by Johnson & Johnson Pharmaceutical Services.
Identification
Copyright
© 2010 American Pain Society. Published by Elsevier Inc. All rights reserved.
