APS Press Room
News Highlights from The Journal of Pain • October 2006
The Peer Review Journal of the American Pain Society
| For immediate release | Contact: Chuck Weber (847) 705-1802 |
CONCERNS ABOUT MEDICATION AND MEDICATION USE IN CHRONIC PAIN
Lance M. McCracken, Julian Hoskins and Christopher Eccleston
Royal National Hospital for Rheumatic Diseases, Bath, England
It’s widely known patients with chronic pain sometimes worry about taking medication. Some toxicology studies have shown about one third of patients with chronic non-cancer pain may be noncompliant with their prescription. This British study was designed to examine concerns of patients related to their use of pain medications. The authors surveyed 220 pain patients and assessed seven areas of patient concerns: addiction, perceived need, unfavorable scrutiny by others, adverse side effects, tolerance, mistrust in the prescribing doctor and withdrawal. Results from the multivariate analysis showed:
- General adherence was primarily predicted by mistrust in the prescribing doctor and by concern over addiction
- Under use of medication was linked with concern over side effects and perceived needs or concerns about withdrawal
- Overuse was predominantly predicted by perceiving medication as needed and secondarily related to concerns about negative scrutiny
- Depression was prevalent in those who perceived medication as needed and worried that one day it will be less effective
- Disability was predicted by concerns over tolerance and side effects.
The authors also reported that distressed chronic pain patients said medication use was associated with further distress. Therefore, fears about treatment and its effects should be considered as a target of additional treatment for these patients.
FACTORS ASSOCIATED WITH EARLY OPIOID PRESCRIBING AMONG WORKERS WITH LOW BACK INJURIES
Bert D. Stover, Judith A. Turner, Gary Franklin, Jeremy V. Glick, Deborah Fulton-Kehoe, Lianne Sheppard, Thomas M. Wickizer, Joel Kaufman and Kathleen Egan
University of Washington Environmental & Occupational Health Sciences
The authors studied 1067 workers in the state of Washington who filed workman’s compensation claims for low back injuries and had at least four days of work-related disability. Little is known about patient characteristics that may influence physicians’ decisions to prescribe opioids for acute back pain. This study is the first to examine factors associated with opioid prescriptions for acute work-related back pain.
The authors found that 35 percent of the injured workers received an opioid prescription at their first health care visit for the injury or during the next six weeks. This is contrary to current practice guidelines for treatment of low back pain that recommend NSAIDS and acetaminophen as first-line analgesics. For workers who received opioids later in the observation period, the authors concluded that persistence of pain led to the prescriptions.
In other findings:
- Workers who reported daily tobacco use had more than twice the odds of receiving opioids than those who do not use tobacco. One possible explanation is that smoking might be a marker for jobs with greater physical demands and more widespread pain
- Hispanics were significantly less likely than non-Hispanic whites to receive opioids
- Poor mental health was significantly associated with receiving an opioid prescription, which confirms a previous study of veterans with chronic pain that showed psychiatric disorders were strong predictors of long-term opioid prescription use
- Workers with possible alcohol abuse problems were not more likely to receive opioids
- Pain severity was significantly associated with opioid prescription. The authors noted that some previous studies have found an association between pain severity and opioid prescribing while others have not.
The authors concluded their findings underscore the need for further research to examine racial and ethnic disparities in prescribing opioids and the reasons for high prescribing for tobacco users. Also, more research is needed to examine the impact of early opioid prescribing on long-term outcomes.
CATASTROPHIZING AND PAIN-CONTINGENT REST PREDICT PATIENT ADJUSTMENT INMEN WITH CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME
Dean A. Tripp, Queen’s University, Kingston Ontario
(There were 13 co-authors from multiple institutions)
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common and very painful urological syndrome with an estimated prevalence of 16 percent among North American males. Despite the proven benefits of psychosocial factors for adjusting to chronic pain, they have largely been ignored regarding CP/CPPS adjustment. The authors believe psychotherapies are given low priority in these patients because they are treated primarily by surgeons. The purpose of the study was to explore biopsychosocial factors predicting pain and disability in men with CP/CPPS.
In the study, catastrophizing, pain-contingent rest, solicitous responses, depression and urinary symptoms were hypothesized to have positive associations with CP/CPPS pain and disability, while perceived control over pain and social support would show negative associations.
The authors evaluated 253 men with CP/CPPS. They found that urinary symptoms, depression and catastrophizing made significant contributions to overall syndrome pain, and the resulting helplessness was a strong predictor of recurrent pain. Secondly, urinary symptoms, pain and pain-contingent rest were predictors of CP/CPPS disability. The authors noted that pain-contingent rest was the strongest predictor of disability. When patients avoid movement as a pain coping strategy, prolonged inactivity reduces mobility.
The study’s findings suggest that cognitive/behavioral variables are important predictors of pain and disability in men with CP/CPPS.