Opioid use behaviors, mental health and pain--development of a typology of chronic pain patients
- PMID: 19473786
- PMCID: PMC2716214
- DOI: 10.1016/j.drugalcdep.2009.03.021
Opioid use behaviors, mental health and pain--development of a typology of chronic pain patients
Abstract
Background: The intersection of pain, addiction and mental health has not been adequately described. We describe the roles of these three conditions in a chronic pain patient population using opioid analgesics. Aims were to improve our understanding of this population as well as to explore ways of identifying different types of patients.
Methods: We conducted a retrospective cohort study in a large integrated group medical practice in Washington State with persons using opioids chronically (n=704). Patient classes were derived with latent class analysis using factors representing DSM-IV opioid abuse and dependence, opioid misuse, pain, anxiety and depression. Regression analyses explored the utility of automated and interview data to distinguish the empirically derived patient groups.
Results: Three classes were identified: a Typical group, the substantial majority that had persistent, moderate mental health and pain symptoms; an Addictive Behaviors group with elevated mental health symptoms and opioid problems, but pain similar to the Typical class; and a Pain Dysfunction class with significantly higher pain interference as well as elevated mental health and opioid problems. Prescribed average daily dose of opioids was three times higher for those in the two atypical groups and was strongly associated with class membership after adjusting for other variables.
Conclusion: We describe three distinct types of patient classes as well as data elements that could help identify the two atypical types. Further research is needed to confirm these findings and determine the utility of this approach in other clinical settings.
Figures
Similar articles
-
Measurement of opioid problems among chronic pain patients in a general medical population.Drug Alcohol Depend. 2009 Sep 1;104(1-2):43-9. doi: 10.1016/j.drugalcdep.2009.03.022. Epub 2009 May 26. Drug Alcohol Depend. 2009. PMID: 19473787 Free PMC article.
-
The association between severity of depression and prescription opioid misuse among chronic pain patients with and without anxiety: A cross-sectional study.J Affect Disord. 2018 Aug 1;235:293-302. doi: 10.1016/j.jad.2018.04.058. Epub 2018 Apr 10. J Affect Disord. 2018. PMID: 29660645
-
Psychological factors as predictors of opioid abuse and illicit drug use in chronic pain patients.J Opioid Manag. 2007 Mar-Apr;3(2):89-100. doi: 10.5055/jom.2007.0045. J Opioid Manag. 2007. PMID: 17520988
-
Opioids and the management of chronic severe pain in the elderly: consensus statement of an International Expert Panel with focus on the six clinically most often used World Health Organization Step III opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone).Pain Pract. 2008 Jul-Aug;8(4):287-313. doi: 10.1111/j.1533-2500.2008.00204.x. Epub 2008 May 23. Pain Pract. 2008. PMID: 18503626
-
Dynamic risk factors in the misuse of opioid analgesics.J Psychosom Res. 2012 Jun;72(6):443-51. doi: 10.1016/j.jpsychores.2012.02.009. Epub 2012 Apr 5. J Psychosom Res. 2012. PMID: 22656441 Review.
Cited by
-
Developing a typology of interventions to support doctors' mental health and wellbeing.BMC Health Serv Res. 2024 May 3;24(1):573. doi: 10.1186/s12913-024-10884-6. BMC Health Serv Res. 2024. PMID: 38702774 Free PMC article.
-
Characteristics of patients with non-cancer pain and long-term prescription opioid use who have used medical versus recreational marijuana.J Cannabis Res. 2024 Feb 22;6(1):7. doi: 10.1186/s42238-024-00218-y. J Cannabis Res. 2024. PMID: 38383471 Free PMC article.
-
Exploratory evaluation of spinal cord stimulation with dynamic pulse patterns: a promising approach to improve stimulation sensation, coverage of pain areas, and expected pain relief.Front Pain Res (Lausanne). 2024 Jan 31;4:1339892. doi: 10.3389/fpain.2023.1339892. eCollection 2023. Front Pain Res (Lausanne). 2024. PMID: 38361978 Free PMC article.
-
Sociocultural factors associated with persistent prescription opioid use (PPOU) among Puerto Rican adults in Massachusetts.PLoS One. 2023 Aug 22;18(8):e0290104. doi: 10.1371/journal.pone.0290104. eCollection 2023. PLoS One. 2023. PMID: 37607191 Free PMC article.
-
Between guidelines and clinical trials: evidence-based advice on the pharmacological management of non-specific chronic low back pain.BMC Musculoskelet Disord. 2023 May 30;24(1):432. doi: 10.1186/s12891-023-06537-0. BMC Musculoskelet Disord. 2023. PMID: 37254090 Free PMC article. Review.
References
-
- Adams LL, Gatchel R, Robinson RC, Polatin P, Gajraj N, Deschner M, Noe C. Development of a self-report screening instrument for assessing potential opioid medication misuse in chronic pain patients. J Pain Symptom Manage. 2004;27:440–459. - PubMed
-
- American Psychiatric Institute. Diagnostic and statistical manual of mental disorder. 4. American Psychiatric Institute; Washington D.C: 1994.
-
- Becker W, Sullivan L, Tetrault J, Desai R, Fiellin D. Non-medical use, abuse and dependence on prescription opioids among U.S. adults: Psychiatric, medical and substance use correlates . Drug Alcohol Depend. 2008;94:38–47. - PubMed
-
- Bendel RB, Afifi AA. Comparison of stopping rules in forward regression. J Am Stat Assoc. 1977;72:46–53.
Publication types
MeSH terms
Substances
Grants and funding
LinkOut - more resources
Full Text Sources
Medical