APS Press Room
News Highlights from The Journal of Pain • July 2007
The Peer Review Journal of the American Pain Society
| For immediate release | Contact: Chuck Weber (847) 705-1802 |
Study Shows Low Opioid Abuse in Primary Care Pain Patients
Some 4% of patients prescribed opioid pain medications by primary care physicians abuse the drugs, but the risk of addiction is small compared with the alternative of continuous pain and suffering from chronic noncancer pain, according to research reported in The Journal of Pain.
Researchers from the University of Wisconsin and University of British Columbia studied 801 patients in primary care practices throughout the state to identify the rate of substance use disorders and opioid abuse in persons who receive long-term opioid therapy from primary care physicians. The most common pain diagnoses in the sample were degenerative arthritis, low back pain, migraines, neuropathy, and fibromyalgia. Patients were between 18 and 81 years old with a diagnosis of chronic noncancer pain.
The primary finding was that the frequency of opioid abuse in this population was 3.8% or about 1 in every 25 patients taking opioid medications. Also, the study reported there was a 24% rate of positive toxicology tests in the opioid-abusing group for illicit drugs and significant underreporting of drug use. Forty-six percent of patients with positive toxicology screens denied illicit drug use even though they were guaranteed anonymity during the interviews. This finding confirms previous studies that patients with chronic pain often mislead physicians about illicit drug use.
The data also showed a high percentage of subjects who abused opioids or other substances also engaged in specific aberrant drug behaviors, such as sedating oneself, using opioids for nonpain reasons, increasing doses without authorization, and feeling intoxicated when using opioids. Previous studies have shown that patients with a family or personal history of substance abuse are more likely to exhibit aberrant drug behaviors.
The authors concluded that considering potential benefits offered by opioids to patients with chronic pain, the 3.8% risk of opioid addiction is small compared to the overall therapeutic benefits of opioid analgesics.
Source: Substance Use Disorders in a Primary Care Sample Receiving Daily Opioid Therapy, Michael F. Flemming, Stacy Balousek, Cynthia L. Klessig, Marlon P. Mundt and David D. Brown, University of Wisconsin and University of British Columbia.
Positive Attitude Increases Pain Tolerance During Vigorous Exercise
Are those with higher levels of self-efficacy about their ability to cope with pain better able to withstand increasing intensity of exercise-induced muscle pain? In this study, researchers from the University of Illinois sought to learn more about the psychological influences on muscle pain during exercise. They defined self-efficacy as “the belief in one’s capabilities to organize and execute the courses of action to produce a given attainment.” The research team recruited 16 healthy and physically active women to participate in 30 minutes of a high-intensity cycling. The self-efficacy scale assessed beliefs in one’s capability to tolerate moderate to strong leg muscle pain during cycling without stopping.
Results showed that self-efficacy for tolerating pain was moderately to strongly and inversely associated with ratings of muscle pain intensity during the cycling exercise. The authors noted their findings support the need for future examinations of strategies for manipulating self efficacy for tolerating pain and possibly reducing muscle pain during exercise. Also, because pain is a possible barrier to exercise initiation and persistence, and thus often a limiting factor in physical therapy and rehabilitation, the authors noted that pain reduction through manipulation of self-efficacy might influence exercise adherence.
Source: Self Efficacy Correlates with Leg Muscle Pain During Maximal and Submaximal Cycling Exercise, Robert W. Motl, Rachael C. Gliottoni and Jennifer A. Scott, University of Illinois at Urbana Champaign.
Burn Pain Still Undertreated
A review conducted by researchers at the University of California-San Francisco showed that although the unmet medical need for more effective pain management for burn patients was described 20 years ago, burn-injury pain remains a continuing challenge. Burn pain is largely undertreated and has been linked to debilitating chronic pain and stress-related disorders.
A reason suggested by the authors for the frustrating inability to control burn pain effectively is that pain levels from wound care and rehabilitation can vary during the three phases of burn recovery-acute, healing, and rehabilitation. The review examined burn pain and its management across the three stages of recovery.
The authors concluded that understanding the mechanisms that contribute to the intensity and variations of burn injury pain over time is crucial for proper pain management. Unfortunately, there is little clinical research to draw from identifying mechanisms of acute and chronic burn-injury pain. Unlike post-surgical pain that diminishes gradually, burn pain is highly variable and may increase over time before healing occurs.
The study reported that several types of analgesics are rarely used for burn patients, even though they appear to have pain-management potential. Clonidine, ketamine, lidocaine and methadone may decrease the need for potent opioids and lessen drug tolerance commonly observed in burn patients. Also, fentanyl has been shown to be most effective for managing pain during wound care procedures, but timing the delivery of this short-acting opioid is difficult without fear of overdosing.
The authors concluded that “Research is needed to identify the underlying mechanisms for burn-injury pain over time. Only with this knowledge will burn care providers be able to target specific mechanisms that contribute to the variable intensity that makes this type of pain such a difficult management problem.”
Source: Burn Injury Pain: The Continuing Challenge, Gretchen J. Summer, Kathleen A. Puntillo, Christine Miaskowski, Paul G. Green and Jon D. Levine, University of California-San Francisco.