Jason W Busse1, Hamza Mahmood2, Bilal Maqbool2, Amna Maqbool3, Ali Zahran4, Adnan Alwosaibai4, Eshaq Alshaqaq5, Nav Persaud6, Lynn Cooper7, Angela Carol8, Janice Sumpton9, Erin McGinnis10, Daniel Rosenbaum11, Natalie Lidster11, D Norman Buckley12. 1. Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ont. ; Department of Anesthesia, McMaster University, Hamilton, Ont. ; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont. 2. Department of Health Sciences, McMaster University, Hamilton, Ont. 3. Department of Biology, McMaster University, Hamilton, Ont. 4. Department of Anesthesia, McMaster University, Hamilton, Ont. 5. Anesthesia Department, Saad Specialist Hospital, Saudi Arabia. 6. Keenan Research Centre in the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ont. ; Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ont. ; Department of Family and Community Medicine, University of Toronto, Toronto, Ont. 7. Canadian Pain Coalition, Oshawa, Ont. 8. Department of Anesthesia, McMaster University, Hamilton, Ont. ; College of Physicians and Surgeons of Ontario, Toronto, Ont. ; Hamilton Urban Core Community Health Centre, Hamilton, Ont. 9. Pharmacy Department, London Health Sciences Centre, London, Ont. 10. Chronic Disease and Injury Prevention Division, Niagara Region Public Health, Thorold, Ont. 11. Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont. 12. Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ont. ; Department of Anesthesia, McMaster University, Hamilton, Ont.
Abstract
BACKGROUND: Characteristics of patients receiving long-term opioid therapy (≥ 6 months) for chronic noncancer pain are poorly understood. We conducted a cross-sectional survey of this patient population to explore demographic variables, pain relief, functional improvement, adverse effects and impressions of an educational pamphlet on long-term opioid therapy. METHODS: We invited 260 adult patients presenting to the Pain Management Centre at the Hamilton General Hospital, Hamilton, Ontario, with chronic noncancer pain to complete a 20-item survey. Patients who presented for procedures were not eligible for our study. We used adjusted logistic regression models to explore the association between higher morphine equivalent dose and pain relief, functional improvement, adverse events and employment. RESULTS: The survey was completed by 170 patients (a response rate of 65.4%). Most respondents (87.6%; 149 out of 170) were receiving long-term opioid therapy, and the median morphine equivalent dose was 180 mg daily (interquartile range 60-501). Most respondents reported at least modest (> 40%) opioid-specific pain relief (74.1%; 106 out of 143) and functional improvement (67.6%; 96 out of 142), and 46.5% (66 out of 142) reported troublesome adverse effects that they attributed to their opioid use. Most patients were receiving disability benefits (68.3%; 99 out of 145) and, among those respondents who were less than 65 years of age (90.3%; 131 out of 145), 10 (7.6%) were working full-time and 14 (10.7%) part-time. In our adjusted analyses, higher morphine equivalent dose was associated with greater self-reported functional improvement (odds ratio [OR] 1.45, 95% confidence interval [CI] 1.07-1.96) but not with pain relief (OR 1.38, 95% CI 1.00-1.89), troublesome adverse effects (OR 0.92, 95% CI 0.70-1.20) or employment (OR 0.80, 95% CI 0.56-1.15). INTERPRETATION: Most outpatients receiving long-term opioid therapy for chronic noncancer pain at a tertiary care chronic pain clinic reported at least moderate pain relief and functional improvement; however, adverse effects were common and few patients were engaged in competitive employment.
BACKGROUND: Characteristics of patients receiving long-term opioid therapy (≥ 6 months) for chronic noncancer pain are poorly understood. We conducted a cross-sectional survey of this patient population to explore demographic variables, pain relief, functional improvement, adverse effects and impressions of an educational pamphlet on long-term opioid therapy. METHODS: We invited 260 adult patients presenting to the Pain Management Centre at the Hamilton General Hospital, Hamilton, Ontario, with chronic noncancer pain to complete a 20-item survey. Patients who presented for procedures were not eligible for our study. We used adjusted logistic regression models to explore the association between higher morphine equivalent dose and pain relief, functional improvement, adverse events and employment. RESULTS: The survey was completed by 170 patients (a response rate of 65.4%). Most respondents (87.6%; 149 out of 170) were receiving long-term opioid therapy, and the median morphine equivalent dose was 180 mg daily (interquartile range 60-501). Most respondents reported at least modest (> 40%) opioid-specific pain relief (74.1%; 106 out of 143) and functional improvement (67.6%; 96 out of 142), and 46.5% (66 out of 142) reported troublesome adverse effects that they attributed to their opioid use. Most patients were receiving disability benefits (68.3%; 99 out of 145) and, among those respondents who were less than 65 years of age (90.3%; 131 out of 145), 10 (7.6%) were working full-time and 14 (10.7%) part-time. In our adjusted analyses, higher morphine equivalent dose was associated with greater self-reported functional improvement (odds ratio [OR] 1.45, 95% confidence interval [CI] 1.07-1.96) but not with pain relief (OR 1.38, 95% CI 1.00-1.89), troublesome adverse effects (OR 0.92, 95% CI 0.70-1.20) or employment (OR 0.80, 95% CI 0.56-1.15). INTERPRETATION: Most outpatients receiving long-term opioid therapy for chronic noncancer pain at a tertiary care chronic pain clinic reported at least moderate pain relief and functional improvement; however, adverse effects were common and few patients were engaged in competitive employment.
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