Background & Aims

The elevated prevalence of opioid prescriptions for individuals suffering from chronic noncancer pain (CNCP) has prompted inquiries into the various factors that shape physicians’ choices when it comes to opioid prescriptions. It has been proposed that the prescription of opioids follows a concerning trend referred to as “adverse selection.” In this pattern, patients with CNCP who have more extensive medical diagnoses, higher comorbidity scores, and consequently, a heightened risk of unfavorable outcomes, tend to be prioritized by physicians for opioid therapy. In this study, we aim to assess the contribution of pain-associated non-cancer illnesses (NCIs) to prescription opioid use among a large cohort of CNCP patients. Predictive modeling was used to understand the patients’ characteristics determining increased opioid use across NCIs.

Methods

Data was obtained from 195,808 CNCP participants from the UK-Biobank. Associations between opioid use and 11 major NCIs as well as the number of reported NCIs were described using odds ratios (ORs). Separate predictive models of opioid use were developed from 1) sociodemographic, lifestyle, mental health, and anthropometric measures (i.e., pain-agnostic model) and 2) acute and chronic pain location (i.e., pain model). Models’ diagnostic abilities were evaluated using Cohen’s-d effect sizes comparing NCI groups with NCI-free group.

Results

Opioid use was associated with all NCIs, with ORs ranging from 5.5, [95%CI:5.49-5.84] for musculoskeletal and trauma comorbidities and 1.29, [95%CI:1.24-1.35] for immunological comorbidities. Opioid use was strongly associated with the number of reported NCIs and the likelihood of using opioids linearly increased with the number of illnesses. The pain-agnostic model showed stronger discriminability between NCI groups and the NCI-free group compared to the pain model, with moderate effect sizes across all categories (average Cohen’s-d=0.40, P-value<0.001).

Conclusions

Our findings suggest that opioid prescription and opioid-related disorders, are both
associated with pain-agnostic characteristics that go beyond the physical pain
experienced by the patients.
? Opioids are more frequently prescribed to patients suffering from comorbid
conditions, and that associations between chronic pain and opioid use may be
confounded by pain-associated illnesses.
? CNCP patients diagnosed with an NCI had significantly higher pain-agnostic risk
scores compared to the NCI-free group, indicating that opioids may be prescribed
to co-treat the patients’ pain and overall poor functioning.

References

1.Busse JW, Wang L, Kamaleldin M, Craigie S, Riva JJ, Montoya L, et al. Opioids for Chronic Noncancer
Pain: A Systematic Review and Meta-analysis. Jama. 2018;320(23):2448-60.
2. Sullivan MD, Ballantyne JC. What are we treating with long-term opioid therapy? Arch Intern Med.
2012;172(5):433-4.
3. Turk DC, Okifuji A. What factors affect physicians’ decisions to prescribe opioids for chronic
noncancer pain patients? The Clinical journal of pain. 1997;13(4):330-6.

Presenting Author

Azin Zare

Poster Authors

Azin Zare

DDS,MSc

McGill University

Lead Author

E-mail

Christophe Tanguay-Sabourine

Lead Author

E-mail

Matt Fillingim

Mcgill

Lead Author

E-mail

Gianluca Guglietti

McGill University

Lead Author

E-mail

Jax Norman

McGill University

Lead Author

E-mail

Ronrick Da-ano

Lead Author

E-mail

Marc O Martel

PhD

McGill University

Lead Author

E-mail

Topics

  • Treatment/Management: Pharmacology: Opioid