Opioid Treatment for Chronic Pain and Interdisciplinary Care

Date

2015-08-31

Journal Title

Journal ISSN

Volume Title

Publisher

Abstract

BACKGROUND: The amount of individuals suffering from chronic pain (3 months or more) is growing. Along with this growth, the amount of money spent on medical treatment of chronic pain with or without relief is growing. A major issue that stems from this is the misuse and abuse of prescription opioid medication. This brings a massive loss of productivity and quality of life. SUBJECTS: Patients included in the current study suffer from chronic pain, are at least 18 years of age, and are capable of providing informed consent, and reading and speaking English. EMCPM provides an interdisciplinary program including; cognitive-behavioral therapy, group cognitive-behavioral therapy focusing on psychoeducation, and physical therapy. Patients receive 8 sessions of individual CBT, group CBT, and physical therapy throughout the program. Patients receive these sessions twice a week throughout the 4 week program. METHOD: This study used outcomes that measure ratings of pain; pain, pain interference, depression, anxiety, sleep disturbance, sleep related impairment, satisfaction with participation in discretionary social activities, satisfaction with social roles and activities, and global health. Opioid status was determined as “no,” “decreased,” or “same” for each patient after oral morphine equivalents were calculated at baseline and monitored throughout the 4-week program. One-way within-subjects ANOVAs were conducted for each opioid status as the factor and the outcome measure T scores as the dependent variable. If significant, polynomial contrasts were used to determine linear effects. One-way within-subjects ANCOVAs were then conducted for each opioid status as the factor, outcome measure T scores as the dependent variable and pre-program outcome measure T scores as the covariate to control for pre-morbid dysfunction. If significant, polynomial contrasts were used to determine linear effects. Finally, three Pearson correlations were run between percent change of outcome measure T scores and pre-, post-, and percent change in morphine equivalents. RESULTS: Overall, individuals with chronic pain who participated in a four-week interdisciplinary pain program maximized their results by maintaining no or low opioid dosage, or by decreasing moderate-high opioid doses throughout the program, as expected. Individuals who entered the interdisciplinary pain program with no opioid use showed significantly more improvement (p<.01) than those with initial opioid use over the course of the program on several outcome measures; pain (composite pain rating and pain interference), depression, anxiety, social satisfaction (satisfaction with participation in discretionary social activities and satisfaction with social roles and activities), and global health. Significant (p<.01) linear effects were also found on all previously mentioned outcome measures. Anxiety levels showed significantly more improvement (p<.01) over the course of the pain program only when a control for pre-morbid anxiety was added. A significant (p<.01) linear effect was also found. Individuals who entered the interdisciplinary pain program using opioid medication and decreased the dosage of opioid medication over the course of the program reported significantly more improvement (p<.01) in pain (both composite pain rating and pain interference) and social satisfaction (satisfaction with participation in discretionary social activities only when controlled for pre-morbid social satisfaction with participation in discretionary social activities) when compared with participants who maintained initial opioid dosage. Significant (p<.01) linear effects were found on all three outcome measures. Individuals who maintained a low opioid dosage over the course of the interdisciplinary pain program reported significantly more improvement (p<.01) on; pain (composite pain rating and pain interference), anxiety, sleep (sleep-related impairment only), social satisfaction (satisfaction with participation in discretionary social activities and satisfaction with social roles and activities), and global health. Significant (p<.01) linear effects were found on all of the above measures except pain related impairment. Weak Pearson correlations (r=22) between pre-morphine equivalent and percent change in sleep-related impairment was found. This was again found between post-morphine equivalent and percent change in sleep-related impairment (r=29), as well as a weak negative correlation with pain interference (r=-.28). More research is indicated to determine the relationship between these correlations. Pearson correlations between percent change in morphine equivalent and percent change in outcome measure T scores did not yield any significant (r>.29) correlations.

General Notes

Table of Contents

Subjects

Analgesics, Opioid, Chronic Pain, Outcome Assessment (Health Care)

Citation

Related URI