Background & Aims
Opioids may affect one’s driving performance through visual, cognitive, and motor impairments (1, 2), and pain itself also may affect attention, cognition, and psychomotor function required for driving (3). There is a need to better assess the effects of opioids prescribed to people with chronic non-cancer pain if they contribute to driving impairments or if they reduce impairments due to alleviation of pain. Our aim was to assess driving performance in a high-fidelity simulator and its association with short-acting opioid prescriptions in a population experiencing chronic non-cancer pain.
Methods
We conducted a controlled cross-sectional study with three groups: Individuals with chronic pain (recruited from a tertiary outpatient pain clinic) were divided into those using short-acting opioids (Group A, n =15) and those not using any opioids (Group B, n = 17). Healthy individuals without chronic pain acted as a control condition (Group C, n = 20).
Participants attended two driving sessions conducted in DriverLab, Canada’s most advanced driving simulator. After baseline assessments of visual scanning speed, motor function, attention and mental flexibility (via Trail Making Test B (TMT-B) (4,5) and the participants useful field of view (UFOV) (6), participants were engaged in a simulated driving session.
The driving outcomes included: mean speed, speed variability, standard deviation of lateral position, brake reaction time, following time, and standard deviation of following time.
Results
Participants’ mean age was 41.9 years and 69% were women. Sleep amount was significantly different among groups: 5.9 hours/night in group A, 6.4 in group B and 7.1 in group C (p< 0.05). Average pain (0-10 scale) was 6.3 in group A, 5.6 in group B and 0.6 in group C (p< 0.05). Only the TMT-B was significantly different among groups: group A: 79.5 (SD 54.6), B: 52.6 (SD 21.3), and C: 44.8 (SD 15) (p<0.05). Some participants dropped out of the study because of simulator sickness and did not complete the driving simulation test. The number of participants who completed the driving test was 12 (group A), 15 (group B) and 14 (group C). All driving simulator measures were similar across all 3 groups. There was a tendency for group A participants to drive at lower speed (89.6 km/h) compared to group B (90.1 km/h) and group C (93 km/h), but this was not significant (p=0.09).
Conclusions
We did not find any association between use of short-acting opioids and driving simulator performance in a population of people with chronic non-cancer pain. The paper-based test TMT-B detected a significant, but small difference among groups, that is possibly not clinically significant.
References
(1) Pask S, Dell’Olio M, Murtagh FEM, Boland JW. The Effects of Opioids on Cognition in Older Adults With Cancer and Chronic Noncancer Pain: A Systematic Review. J Pain Symptom Manage. 2019 Oct 31. pii: S0885-3924(19)30639-6. PMID:31678462.
(2) Allegri N, Mennuni S, Rulli E, Vanacore N, Corli O, Floriani I, De Simone I,Allegri M, Govoni S, Vecchi T, Sandrini G, Liccione D, Biagioli E. Systematic Review and Meta-Analysis on Neuropsychological Effects of Long-Term Use of Opioids in Patients With Chronic Noncancer Pain. Pain Pract. 2019 Mar;19(3):328-343.PMID: 30354006.
(3) Moriarty O, McGuire BE, Finn DP. The effect of pain on cognitive function: a review of clinical and preclinical research. Prog Neurobiol. 2011 Mar;93(3):385-404. PubMed PMID: 21216272.
(4) Reitan RM. Validity of the Trail Making Test as an indicator of organic brain damage. Perceptual and motor skills. 1958 Dec;8(3):271-6.
(5) Kurita GP, Mattos Pimenta CA, Braga PE, Frich L, Jørgensen MM, Nielsen PR, Højsted J, Sjøgren P. Cognitive function in patients with chronic pain treated with opioids: characteristics and associated factors. Acta anaesthesiologica Scandinavica. 2012 Nov 1;56(10):1257-66.
(6) Ball K, Owsley C, Sloane ME, Roenker DL, Bruni JR. Visual attention problems as a predictor of vehicle crashes in older drivers. Investigative ophthalmology & visual science. 1993 Oct 1;34(11):3110-23.
(7) Haghzare, S., Campos, J. L., Bak, K., & Mihailidis, A. (2021). Older adults’ acceptance of fully automated vehicles: Effects of exposure, driving style, age, and driving conditions. Accident; analysis and prevention, 150, 105919.
Presenting Author
Andrea Furlan
Poster Authors
Andrea Furlan
MD, PhD
IWH
Lead Author
Jennifer Campos
KITE Institute, UHN
Lead Author
Behrang Keshavarz
KITE Institute, UHN
Lead Author
Bruce Haycock
KITE Institute, UHN
Lead Author
Geoff Fernie
KITE Institute, UHN
Lead Author
Tiffany Got
University of Toronto
Lead Author
Noah Lipin
KITE Institute
Lead Author
Topics
- Treatment/Management: Pharmacology: Opioid