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The work status and pain-related impairment of individuals on chronic opioid therapy & the opioid therapy’s efficacy and therapeutic effect: a correlation study

      This retrospective study correlated the pain-related impairment (PRI) and work status of individuals on chronic opioids (ICO) with clinician-derived efficacy and therapeutic effect. Seventy-six subjects completed the Pain Disability Questionnaire (PDQ), sub-categorized to Functional (PDQ-FS) and Psychosocial Status (PDQ-PS) components. The physician scored Clinician Global Impressions via: Efficacy Index (CGI-EI), determining chronic opioid therapy (COT) interference with functioning, and Therapeutic Effect (CGI-TE), recording ICO symptom improvement. Mean scores were: PDQ-FS 45.4 (SD=22.01), PDQ-PS 32.1 (SD=13.31), and PDQ-Total 77.8 (SD=33.65). CGI-EI scores were either “none” (89.5%) or “no significant interference” (10.5%). CGI-TE scores were either “moderate” (36.8%) or “marked” (63.2%). 52.6% reported they were working, 11.8% reported not working, and 35.5% were retired/disabled. As a sample, Spearman’s correlations were significant (p<.05) for all measures except for CGI-EI. For subjects with mild/moderate pain (M/M), CGI-EI significantly correlated with PDQ-FS (rs=.304, p=.024) and CGI-TE (rs=-.430, p<.001). There were no significant correlations for severe/extreme pain patients (S/E) and CGI. Cross-tabulation showed pain severity and CGI-TE were not independent (χ2=14.918, p<.001): more M/M scoring “marked”, and fewer S/E scoring “moderate” than expected by chance. Work significantly correlated with PRI (rs=.487, p<.001). PRI was not independent of work status (χ2=20.953, p<.001): more M/M and far fewer S/E reported working than expected by chance. Work was also related to CGI-TE (χ2=34.468, p<.001): those with moderate CGI-TE were more likely retired/disabled; and, those with marked CGI-TE more likely than expected to be working. Most ICO patients with moderate PRI report working. COT had no significant functioning interference and led to marked symptom improvement. The study delineated COT’s positive benefits on work status and concluded that the PDQ and CGI are useful in assessing ICO’s pain, which correlates with work status. Further study on population subsets, such as with Chronic Back Pain, would be beneficial.