Background & Aims
For chronic pain conditions (pain > 3 months), the evidence for the effectiveness of opioid therapy is scarce, but opioids may be considered for well-monitored patients that respond to treatment (1, 2). However, opioids, especially long-term opioid therapy (LTOT), i.e., > 3 months, are associated with several dose-dependent risks, e.g., impaired cognition, increased morbidity and mortality, overdose-related deaths, opioid dependence, and prescription opioid use disorder (P-OUD) (3-5). Pain and psychiatric conditions are risk factors for drug dependence and substance use disorders (SUD) and carry additional risk when both are present. The aim of this project was to examine a) What patient characteristics are associated with LTOT? b) What patient characteristics, including opioid use, are associated with problematic opioid use, here defined as P-OUD, in a sample of individuals seeking treatment in specialized pain care?
Methods
This cross-sectional study was part of the Uppsala Pain cohort (U-PAIN), a prospective clinical cohort, with the overall aim of identifying predictors for risks and benefits associated with opioid-use in chronic pain. Baseline data from a total of 338 participants with chronic pain, planned for their first visit to a university hospital pain clinic, were included in the present study. At baseline, participants were classified into 4 groups based on their self-reported current use of opioids: 1) No use; 2) Short-term or intermittent use (regular use < 3 months or intermittent use up to 10 days/months); 3) LTOT with doses of < 100 mg oral morphine milligram equivalent dose (MEE); 4) LTOT with doses of > 100 mg MME. P-OUD were defined as in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Bio-psycho-social characteristics were assessed with psychometric sound measures. Data were analyzed with descriptive statistics and binary logistic regression.
Results
Data analysis is ongoing. The results on interferential statistics regarding association between bio-psycho-social factors and long-term opioid therapy, as well as P-OUD will be presented at the congress. Participant characteristics are presented below.
Among the 338 participants, mean age was 53 (SD 16), included 203 (60%) women, 94 (30%) had a university degree, and 262 (78%) reported pain > 3 years. Mean worst pain was 7.8 (SD 1.7) and pain on average 6.5 (SD 1.6). Mean health-related quality of life (EQ-VAS 0-100) was 41 (SD 20), and mean pain interference (BPI, composite score) was 6.5 (SD 2.2). Of the total sample, 145 (43%) had no use of opioids, and 193 (57%) were on opioid therapy; short-term or intermittent use n=35 (10%), LTOT <100 mg MME n=134 (40%), LTOT >100 mg MME n=24 (7%). P-OUD latest 12 months were present in total 43 (13%) of the participants; mild P-OUD n=28 (8 %), moderate or severe P-OUD n =15 (4 %). Among the 158 participants with LTOT, 34 (21%) had P-OUD.
Conclusions
This study provides information on opioid use, how it is associated with a large number of bio-psycho-social factors, and whether these associations are dose-dependent in a sample with a relatively high proportion of opioid users (6, 7). The study has some limitations, especially its cross-sectional design, which impedes us from drawing any conclusions on causal relationships between different factors and opioid use.
References
1.Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain – United States, 2022. MMWR Recomm Rep. 2022;71(3):1-95.
2.Bialas P, Maier C, Klose P, Häuser W. Efficacy and harms of long-term opioid therapy in chronic non-cancer pain: Systematic review and meta-analysis of open-label extension trials with a study duration ?26 weeks. 2020;24(2):265-78.
3.Ballantyne J. Opioid Analgesia: Perspectives on
Right Use and Utility. Pain physician. 2007(10):479-91.
4.Ballantyne JC. “Safe and effective when used as directed”: the case of chronic use of opioid analgesics. J Med Toxicol. 2012;8(4):417-23.
5.Nury E, Schmucker C, Nagavci B, Motschall E, Nitschke K, Schulte E, et al. Efficacy and safety of strong opioids for chronic noncancer pain and chronic low back pain: a systematic review and meta-analyses. 2022;163(4):610-36.
6.Grelz H, Fischer MR, Priouzifard M, Midlöv P, Ringqvist Å. Prevalence of Long-Term Opioid Therapy in a Chronic Non-Cancer Pain Population Attending a University-Based Tertiary Pain Clinic in Sweden: A Cross-Sectional Study. J Rehabil Med. 2022;54:jrm00270.
7.Kallman TF, Bäckryd E. Prevalence of analgesic use in patients with chronic pain referred to a multidisciplinary pain centre and its correlation with patient-reported outcome measures: A cross-sectional, registry-based study. J Rehabil Med. 2020;52(11):jrm00126.
Presenting Author
Sofia Wagner
Poster Authors
Sofia Wagner, MSc
PT, MSc
Uppsala University, Department of Women's and Children's Health
Lead Author
Hanna Ljungvall
Department of Pharmacy, Social Pharmacy, University of Uppsala
Lead Author
Hedvig Zetterberg
PhD
Uppsala university, Department of Women's and Children's Health
Lead Author
Rolf Karlsten
PhD
Uppsala University, Department of Surgical Sciences
Lead Author
Pernilla Åsenlöf
PhD
Uppsala Univeristy, Department of Women's and Children's Health
Lead Author
Topics
- Treatment/Management: Pharmacology: Adverse effects