Advertisement

The Initiation of Chronic Opioids: A Survey of Chronic Pain Patients

Published:December 02, 2016DOI:https://doi.org/10.1016/j.jpain.2016.11.001

      Highlights

      • Chronic (>90 days) opioid users (n = 115) were surveyed about their initial prescription.
      • Patients used opioids for postoperative (27%) and injury-related pain (27%).
      • Surgeons (30%), pain (29%), and primary physicians (21%) were the prescribers.
      • Patients initiated opioids without a clear treatment plan or opioid agreement.
      • Twenty-four percent were taking opioids for a different indication than the initiating reason.

      Abstract

      This study reports the results of a researcher-administered survey with 115 patients receiving chronic opioid therapy (>90 days) to obtain information regarding how chronic opioid therapy was started. Chronic opioids were started after surgery (27.0%, 95% confidence interval [CI], 18.5–35.5) or for the treatment of acute injury-related pain (27.0%, 95% CI, 18.5–35.5). Many who initiated opioid therapy after surgery reported postoperative complications (61.3%, 95% CI, 50.8–71.8) and many with injury-related pain reported follow-up corrective surgery (58.1%, 95% CI, 47.5–68.7), which led to the continuation of opioids. A large percentage of patients had concurrent depression (43.5%, 95% CI, 34.0–53.0) and anxiety (23.5%, 95% CI, 15.3–31.7). Many participants had a medical history of aberrant drug-related behavior (32.5%, 95% CI, 23.5–41.5) and self-reported history of addiction (21.7%, 95% CI, 13.7–29.7). Almost one-quarter reported taking opioids for a different indication than that for which opioids were started (95% CI, 26.6–45.0). Patients receiving long-term opioid therapy often transitioned to chronic use after starting opioids for the short-term treatment of postoperative or injury-related pain. It is not evident if a clear decision to continue opioids on a chronic basis was made. This survey provides insight as to how chronic opioid therapy is started, and may suggest opportunities for improved patient selection for opioid therapy.

      Perspective

      This article explores the reasons why patients using chronic opioid therapy (>90 days) initiated opioid medications. The results of this study may help clinicians better select patients for chronic opioid therapy.

      Key words

      To read this article in full you will need to make a payment
      Subscribe to The Journal of Pain
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Abdel Shaheed C.
        • Maher C.G.
        • Williams K.A.
        • Day R.
        • McLachlan A.J.
        Efficacy, tolerability, and dose-dependent effects of opioid analgesics for low back pain: A systematic review and meta-analysis.
        JAMA Intern Med. 2016; 176: 958-968
        • Alam A.
        • Gomes T.
        • Zheng H.
        • Mamdani M.M.
        • Juurlink D.N.
        • Bell C.M.
        Long-term analgesic use after low-risk surgery: A retrospective cohort study.
        Arch Intern Med. 2012; 172: 425-430
        • American Pain Society
        Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain.
        5th ed. American Pain Society, Glenview, IL2003
        • Banta-Green C.J.
        • Merrill J.O.
        • Doyle S.R.
        • Boudreau D.M.
        • Calsyn D.A.
        Opioid use behaviors, mental health and pain–development of a typology of chronic pain patients.
        Drug Alcohol Depend. 2009; 104: 34-42
        • Clarke H.
        • Soneji N.
        • Ko D.T.
        • Yun L.
        • Wijeysundera D.N.
        Rates and risk factors for prolonged opioid use after major surgery: Population based cohort study.
        BMJ. 2014; 348: g1251
        • Correa D.
        • Farney R.J.
        • Chung F.
        • Prasad A.
        • Lam D.
        • Wong J.
        Chronic opioid use and central sleep apnea: A review of the prevalence, mechanisms, and perioperative considerations.
        Anesth Analg. 2015; 120: 1273-1285
        • Dobscha S.K.
        • Morasco B.J.
        • Duckart J.P.
        • Macey T.
        • Deyo R.A.
        Correlates of prescription opioid initiation and long-term opioid use in veterans with persistent pain.
        Clin J Pain. 2013; 29: 102-108
        • Dowell D.
        • Haegerich T.M.
        • Chou R.
        CDC guideline for prescribing opioids for chronic pain - united states, 2016.
        MMWR Recomm Rep. 2016; 65: 1-49
        • Edlund M.J.
        • Martin B.C.
        • Russo J.E.
        • DeVries A.
        • Braden J.B.
        • Sullivan M.D.
        The role of opioid prescription in incident opioid abuse and dependence among individuals with chronic noncancer pain: The role of opioid prescription.
        Clin J Pain. 2014; 30: 557-564
        • Florence C.S.
        • Zhou C.
        • Luo F.
        • Xu L.
        The economic burden of prescription opioid overdose, abuse, and dependence in the United States, 2013.
        Med Care. 2016; 54: 901-906
        • Gaskell H.
        • Derry S.
        • Stannard C.
        • Moore R.A.
        Oxycodone for neuropathic pain in adults.
        Cochrane Database Syst Rev. 2016; 7: CD010692
        • Goesling J.
        • Moser S.E.
        • Zaidi B.
        • Hassett A.L.
        • Hilliard P.
        • Hallstrom B.
        • Clauw D.J.
        • Brummett C.M.
        Trends and predictors of opioid use after total knee and total hip arthroplasty.
        Pain. 2016; 157: 1259-1265
        • Gummesson C.
        • Isacsson S.O.
        • Isacsson A.H.
        • Andersson H.I.
        • Ektor-Andersen J.
        • Ostergren P.O.
        • Malmo H.B.
        The transition of reported pain in different body regions–a one-year follow-up study.
        BMC Musculoskelet Disord. 2006; 7: 17
        • Johnson S.P.
        • Chung K.C.
        • Zhong L.
        • Shauver M.J.
        • Engelsbe M.J.
        • Brummett C.
        • Waljee J.F.
        Risk of prolonged opioid use among opioid-naive patients following common hand surgery procedures.
        J Hand Surg Am. 2016; ([Epub ahead of print])
        • Kraus C.N.
        • Baldwin A.T.
        • Curro F.A.
        • McAllister Jr., R.G.
        Clinical implications of patient-provider agreements in opioid prescribing.
        Curr Drug Saf. 2015; 10: 159-164
        • Kuo Y.F.
        • Raji M.A.
        • Chen N.W.
        • Hasan H.
        • Goodwin J.S.
        Trends in opioid prescriptions among Part D Medicare recipients from 2007 to 2012.
        Am J Med. 2016; 129: 221.e21-221.e30
        • Levy B.
        • Paulozzi L.
        • Mack K.A.
        • Jones C.M.
        Trends in opioid analgesic-prescribing rates by specialty, U.S., 2007–2012.
        Am J Prev Med. 2015; 49: 409-413
        • Lovich-Sapola J.
        • Smith C.E.
        • Brandt C.P.
        Postoperative pain control.
        Surg Clin North Am. 2015; 95: 301-318
        • Ohtori S.
        • Inoue G.
        • Orita S.
        • Ohtori S.
        • Inoue G.
        • Orita S.
        • Eguchi Y.
        • Ochiai N.
        • Kishida S.
        • Takaso M.
        • Aoki Y.
        • Kuniyoshi K.
        • Nakamura J.
        • Ishikawa T.
        • Arai G.
        • Miyagi M.
        • Kamoda H.
        • Suzuki M.
        • Toyone T.
        • Takahashi K.
        Transdermal fentanyl for chronic low back pain.
        Yonsei Med J. 2012; 53: 788-793
        • Turner B.J.
        • Liang Y.
        Drug overdose in a retrospective cohort with non-cancer pain treated with opioids, antidepressants, and/or sedative-hypnotics: Interactions with mental health disorders.
        J Gen Intern Med. 2015; 30: 1081-1096
        • Van Ryswyk E.
        • Antic N.A.
        Opioids and sleep-disordered breathing.
        Chest. 2016; 150: 934-944
        • Webster B.S.
        • Verma S.K.
        • Gatchel R.J.
        Relationship between early opioid prescribing for acute occupational low back pain and disability duration, medical costs, subsequent surgery and late opioid use.
        Spine (Phila Pa 1976). 2007; 32: 2127-2132
        • Wilkerson R.G.
        • Kim H.K.
        • Windsor T.A.
        • Mareiniss D.P.
        The opioid epidemic in the United States.
        Emerg Med Clin North Am. 2016; 34: e1-e23