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Benzodiazepine use in patients with chronic pain in an interdisciplinary pain rehabilitation program

Authors Cunningham JL, Craner JR, Evans MM, Hooten WM

Received 29 September 2016

Accepted for publication 18 November 2016

Published 9 February 2017 Volume 2017:10 Pages 311—317

DOI https://doi.org/10.2147/JPR.S123487

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Lucy Goodman

Peer reviewer comments 2

Editor who approved publication: Dr Michael Schatman

Julie L Cunningham,1 Julia R Craner,2,3 Michele M Evans,2 W Michael Hooten4

1Department of Pharmacy, Mayo Clinic College of Medicine, Rochester, MN, 2Department of Psychiatry and Psychology, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, MN, 3Department of Psychiatry and Behavioral Medicine, Spectrum Health System, Grand Rapids, MI, 4Department of Anesthesiology, Mayo Clinic, and Mayo Clinic College of Medicine, Rochester, MN, USA


Objectives:
In the context of widespread opioid use, increased emphasis has been placed on the potentially deleterious effects of concurrent benzodiazepine (BZD) and opioid use. Although use of opioids in chronic pain has been a major focus, BZD use is equally concerning. Thus, the primary aim of this study was to determine the associations between BZD and opioid use in adults with chronic pain upon admission to an outpatient interdisciplinary pain rehabilitation (IPR) program.
Methods: The study cohort involved 847 consecutive patients admitted to a 3-week outpatient IPR program from January 2013 through December 2014. Study variables included baseline demographic and clinical characteristics, Center for Epidemiologic Studies-Depression Scale, Pain Catastrophizing Scale, and the pain severity subscale of the Multidimensional Pain Inventory.
Results: Upon admission, 248 (29%) patients were taking BZDs. Patients using BZDs were significantly more likely to use opioids and to be female. Additionally, patients using BZDs had significantly greater depression, pain catastrophizing, and pain severity scores. In univariable logistic regression analysis, opioid use, female sex, and greater scores of depression, pain catastrophizing, and pain severity were significantly associated with BZD use. In multivariable logistic regression analysis adjusted for age, sex, pain duration, opioid use, depression, pain catastrophizing, and pain severity, only female sex and greater depression scores were significantly associated with BZD use.
Discussion: Among patients participating in an outpatient IPR program, female sex and greater depression scores were associated with BZD use. Results identify a high prevalence of BZD use in patients with chronic pain and reinforce the need to weigh the risks versus benefits when prescribing in this patient population.

Keywords: benzodiazepine, chronic pain, opioid, pain rehabilitation

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