Who gets high-dose opioid therapy for chronic non-cancer pain?

Department of Psychiatry and Behavioral Sciences, Box 356560, University of Washington, 1959 NE Pacific St Seattle, WA 98195, USA.
Pain (Impact Factor: 5.84). 12/2010; 151(3):567-8. DOI: 10.1016/j.pain.2010.08.036
Source: PubMed
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    ABSTRACT: This study investigates utilisation patterns for prescription opioid analgesics in the Australian community and how these are associated with a framework of individual-level factors related to healthcare use. Self-reported demographic and health information from participants in the 45 and Up Study cohort were linked to pharmaceutical claims from 2006-2009. Participants comprised 19,816 people with ≥1 opioid analgesic dispensing in the 12-months after recruitment to the cohort and 79,882 people not dispensed opioid analgesics. All participants were aged ≥45 years, were social security pharmaceutical beneficiaries, with no history of cancer. People dispensed opioid analgesics were classified as having acute (dispensing period <90 days), episodic (≥90 days and <3 'authority' prescriptions for increased quantity supply) or long-term treatment (≥90 days and ≥3 authority prescriptions). Of participants dispensed opioid analgesic 52% received acute treatment, 25% episodic treatment and 23% long-term treatment. People dispensed opioid analgesics long-term had an average of 14.9 opioid analgesic prescriptions/year from 2.0 doctors compared with 1.5 prescriptions from 1.1 doctors for people receiving acute treatment. People dispensed opioid analgesics reported more need-related factors such as poorer physical functioning and higher psychological distress. Long-term users were more likely to have access-related factors such as low-income and living outside major cities. After simultaneous adjustment, association with predisposing health factors and access diminished, but indicators of need such as osteoarthritis treatment, paracetamol use, and poor physical function were the strongest predictors for all opioid analgesic users. People dispensed opioid analgesics were in poorer health, reported higher levels of distress and poorer functioning than people not receiving opioid analgesics. Varying dispensing profiles were evident among people dispensed opioid analgesics for persistent pain, with those receiving episodic and long-term treatment dispensed the strongest opioid analgesics. The findings highlight the broad range of factors associated with longer term opioid analgesics use.
    PLoS ONE 12/2013; 8(12):e80095. DOI:10.1371/journal.pone.0080095 · 3.53 Impact Factor
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    ABSTRACT: Substance use disorders are common in primary care settings, but detection, assessment, and management are seldom undertaken. Substantial evidence supports alcohol screening and brief intervention for risky drinking, and pharmacotherapy is effective for alcohol use disorders. Substance use disorders can complicate the management of chronic noncancer pain, making routine monitoring and assessment for substance use disorders an important aspect of long-term opioid prescribing. Patients with opioid use disorders can be effectively treated with methadone in opioid treatment programs or with buprenorphine in the primary care setting.
    Medical Clinics of North America 09/2014; 98(5):1097–1122. DOI:10.1016/j.mcna.2014.06.008 · 2.80 Impact Factor
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    ABSTRACT: The recent increase in the number of patients taking opioids chronically for pain has not yielded the expected benefits in reduction of symptoms and improved function. Chronic pain patients typically respond well initially to opioid medications, but regular use is associated with adverse psychological and physical effects. Patients with significant psychiatric comorbidity and substance use issues are more likely to stay on opioids and to receive higher doses. In the common rheumatological conditions of fibromyalgia and osteoarthritis, opioid treatment is of limited benefit because of lack of efficacy and prominent side effects. Chronic opioid therapy may be more usefully regarded as a form of comfort care, reserved for those patients who have exhausted other treatments and prospects of recovery.
    Current Rheumatology Reports 03/2013; 15(3):311. DOI:10.1007/s11926-012-0311-1 · 2.45 Impact Factor