Problems and concerns of patients receiving chronic opioid therapy for chronic non-cancer pain

Abstract

The value of chronic opioid therapy (COT) for chronic non-cancer pain (CNCP) patients is determined by a balance of poorly understood benefits and harms. Traditionally, this balance has been framed as the potential for improved pain control versus risks of iatrogenic addiction, drug diversion, and aberrant drug-related behaviors. These potential harms are typically defined from the providers' perspective. This paper seeks to clarify difficulties with the long-term use of opioids for CNCP from the patients' perspective. We used the Prescribed Opioids Difficulties Scale (PODS) to assess current problems and concerns attributed to opioid use by 1144 adults receiving COT. Subjects were grouped into low (56.9%), medium (25.6%) and high (17.5%) PODS scorers. Among patients with high PODS scores, 64% were clinically depressed and 78% experienced high levels of pain-related interference with activities, compared to 28% depressed and 60% with high interference with activities among those with low PODS scores. High levels of opioid-related problems and concerns were not explained by differences in pain intensity or persistence. Patients with medium to high PODS scores were often concerned about their ability to control their use of opioid medications, but prior substance abuse diagnoses and receiving excess days supply of opioids were much less common in these patients than depression and pain-related interference with activities. These results suggest two types of potential harm from COT attributed by CNCP patients to opioids: psychosocial problems that are distinct from poor pain control and opioid control concerns that are distinct from opioid misuse or addiction.

Fig. 1

Fig. 1a. Profile of problems attributed by patients to opioid use by total Prescribed Opioid Difficulties Scale score group (low, medium, and high). Fig. 1b. Profile of concerns about opioid control by total Prescribed Opioid Difficulties Scale score group (low, medium, and high).

Fig. 1

Fig. 1a. Profile of problems attributed by patients to opioid use by total Prescribed Opioid Difficulties Scale score group (low, medium, and high). Fig. 1b. Profile of concerns about opioid control by total Prescribed Opioid Difficulties Scale score group (low, medium, and high).

Fig. 2

Percent of patients with clinical depression, high pain interference and high pain impact by level of Prescribed Opioid Difficulties.

Fig. 3

Percent of patients with substance abuse diagnosis (in the prior 3 years) and with excess opioid days supply (in past 6 months) by the level of Prescribed Opioid Difficulties.

Fig. 4

Percent of patients rating their average pain over the prior 3 months as 5 or greater (0–10 scale) and rating opioid medications as very or extremely helpful for relieving pain by the level of Prescribed Opioid Difficulties.