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: 4.01).
10/2005; 6(9):620-9. DOI: 10.1016/j.jpain.2005.04.004
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.
Available from: Mary Catherine George
- "Clinical guidelines suggest that this risk might be mitigated by careful patient selection and monitoring, but what does this mean in the day-to-day practice of caring for HIV-infected patients with chronic pain? Studies outside the realm of HIV have identified risk factors for prescription opioid misuse, including past drug or alcohol abuse (Ives et al., 2006; Michna et al., 2004; Schieffer et al., 2005), younger age (Edlund et al., 2010; Ives et al., 2006), male sex (Edlund, Steffick, Hudson, Harris, & Sullivan, 2007; Ives et al., 2006; Liebschutz et al., 2010), psychiatric comorbidity (Ives et al., 2006), lower education level (Wasan et al., 2007), family history of substance use (Liebschutz et al., 2010; Michna et al., 2004), and history of having been the victim of abuse (Wasan et al., 2007). The ethical difficulty a provider would face in putting these risk factors to practical use is immediately apparent. "
Available from: Leon McDougle
- "An extensive collection of self-administered assessment tools has been developed to capture patients’ experiences and beliefs related to a broad spectrum of psychosocial outcomes resulting from living with chronic pain. Specifically, survey-based tools can assess dimensions such as patients’ acceptance of chronic pain symptoms,4 pain management self-efficacy,5 perceptions regarding the purposes and benefits of pain medication,6 extent of pain-related anxiety,7 and recent and current pain intensity.8 In addition, qualitative data collection methods have uncovered extensive portrayals of the daily realities of patients living with chronic pain. "
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Although psychometrically sound pain assessment tools are available, there is a paucity of research that comprehensively defines chronic pain from the perspective of patients. The purpose of this study was to examine the utility of a combination of qualitative methods (Photovoice, one-on-one interviews, and focus groups) in examining the daily experiences of primary care patients living with chronic pain.
A sample of English-speaking primary care patients aged 30 years or older, who had been prescribed an opioid for long-term, noncancer pain management, participated in the study. Each patient took photographs that best reflected both his/her experiences with chronic pain and what he/she would like his/her life to be without chronic pain.
Patients submitted an average of 20.2±3.1 photographs (range =8–27 photographs). Analysis of one-on-one interviews illuminated five dominant themes: daily need for multiple medications, including opioids; difficulties climbing a flight of stairs; struggling to get out of bed in the morning; extreme challenges with participating in day-to-day life activities; and experiencing feelings of hopelessness and helplessness on a regular basis. Seven themes emerged from the focus groups: undesired effects/burdens of medications, loss of/striving for independence, effect on social interactions/relationships, pain effect on activities of daily living, constant search for convenience/a better situation, interactions with physicians, and frustration/depression with pain.
The qualitative methods employed in this study provide deep insight into perceptions and experiences of patients living with chronic pain that is vital for informing future clinical interventions.
Available from: Nicole Blay
- "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.
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