Schieffer BM, Pham Q, Labus J, et al. Pain medication beliefs and medication misuse in chronic pain

Veteran's Administration Greater Los Angles Healthcare System, Los Angeles, CA 90073, USA.
Journal of Pain (Impact Factor: 4.22). 10/2005; 6(9):620-9. DOI: 10.1016/j.jpain.2005.04.004
Source: PubMed

ABSTRACT This study assessed the influence of medication beliefs, symptom severity, disability, mood, and psychiatric history on opiate medication misuse behaviors in 288 chronic pain patients. Data were gathered by questionnaires and systematic reviews of electronic medical records. The results demonstrate that patients with a history of substance abuse, compared to those without, showed greater medication misuse despite similar dosages and self-rated opiate effectiveness. Misusers believed more strongly in the potential for opiate addiction and that they required higher doses than others, but also had greater belief in opiate effectiveness and the importance of free access. Although both anxiety and substance abuse history are related to medication misuse, a multivariate analysis indicated that these factors can be seen as mediated by medication beliefs. These data suggest important roles for historical, affective, and cognitive variables in understanding medication misuse. Patients with a history of substance abuse report stronger beliefs in opiate effectiveness while simultaneously showing awareness of their addiction potential. Providers may help patients by addressing these issues prior to prescribing opiates. PERSPECTIVE: History of substance abuse is associated with increased opiate medication misuse independent of differences in reported opiate effectiveness. Self-attributions regarding opiate treatment related to need for higher doses, dose control, and addiction potential, may be important mediators of this relationship and interact with anxiety to produce heightened risk of opiate misuse.

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    • "Reported analgesic effi cacy was higher in those SU prescribed opioids (with or without adjunct therapy) compared to those prescribed alternative analgesics, confi rming recommendations that opioids are the most appropriate analgesic for this population. On the other hand, substance users' beliefs in the effi cacy of opioid analgesia is higher than that of the non-user population (Schieffer et al., 2005) and was, to some extent, refl ected in their comments . Consideration should therefore be given to the presence of physiological changes, such as "
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    ABSTRACT: Abstract The aim of this exploratory study was to examine substance users' perspectives towards their acute pain management in the acute hospital setting. Barriers to optimal pain management in the substance user population include: altered physiologic responses to analgesia; cultural values; and health professionals' perceptions of drug-seeking behaviours.
    Contemporary nurse: a journal for the Australian nursing profession 10/2012; 42(2):289-97. DOI:10.5172/conu.2012.42.2.289 · 0.65 Impact Factor
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    • "Adapted from Ballantyne (2007). The psychosocial factors considered to be most predictive of opioid abuse are the presence of psychiatric disorders (Compton et al., 1998; Sullivan et al., 2006) and a personal and/or family history of substance abuse or drug abuse (Dunbar & Katz, 1996; Schieffer et al., 2005). A significant correlation has been found between chronic pain, mood disorders and aberrant drug use: patients with chronic pain report higher levels of anxiety and depression than patients with other medical conditions, and the incidence of mood disorders has been shown to be higher in patients at high risk of opioid misuse or dependence (Bair et al., 2003; Dersh et al., 2002; Fishbain, 1999). "
    Pain Management - Current Issues and Opinions, 01/2012; , ISBN: 978-953-307-813-7
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    • "Further, there is misuse of opioids that does not rise to the level of DSM-IV abuse or dependence. Estimates of rates of opioid abuse, dependence, and misuse vary, and risk factors for (i.e., the factors associated with) opioid abuse/dependence and misuse have varied according to the population studied (Chabal et al., 1997; Chelminski et al., 2005; Cowan et al., 2003; Jonasson et al., 1998; Michna et al., 2004; Reid et al., 2002; Schieffer et al., 2005). For example, a recent review of clinical surveys of patients on COT found widely varying (3% to 62%) estimates of the prevalence of opioid misuse (Turk et al., 2008). "
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    ABSTRACT: To estimate the prevalence of and risk factors for opioid abuse/dependence in long-term users of opioids for chronic pain, including risk factors for opioid abuse/dependence that can potentially be modified to decrease the likelihood of opioid abuse/dependence, and non-modifiable risk factors for opioid abuse/dependence that may be useful for risk stratification when considering prescribing opioids. We used claims data from two disparate populations, one national, commercially insured population (HealthCore) and one state-based, publicly insured (Arkansas Medicaid). Among users of chronic opioid therapy, we regressed claims-based diagnoses of opioid abuse/dependence on patient characteristics, including physical health, mental health and substance abuse diagnoses, sociodemographic factors, and pharmacological risk factors. Among users of chronic opioid therapy, 3% of both the HealthCore and Arkansas Medicaid samples had a claims-based opioid abuse/dependence diagnosis. There was a strong inverse relationship between age and a diagnosis of opioid abuse/dependence. Mental health and substance use disorders were associated with an increased risk of opioid abuse/dependence. Effects of substance use disorders were especially strong, although mental health disorders were more common. Concerning opioid exposure; lower days supply, lower average doses, and use of Schedule III-IV opioids only, were all associated with lower likelihood of a diagnosis of opioid abuse/dependence. Opioid abuse and dependence are diagnosed in a small minority of patients receiving chronic opioid therapy, but this may under-estimate actual misuse. Characteristics of the patients and of the opioid therapy itself are associated with the risk of abuse and dependence.
    Drug and alcohol dependence 11/2010; 112(1-2):90-8. DOI:10.1016/j.drugalcdep.2010.05.017 · 3.28 Impact Factor
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