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Factors associated with prescription opioid misuse in a cross-sectional cohort of patients with chronic non-cancer pain

Authors Hah JM, Sturgeon JA, Zocca J, Sharifzadeh Y, Mackey SC

Received 9 January 2017

Accepted for publication 7 March 2017

Published 3 May 2017 Volume 2017:10 Pages 979—987

DOI https://doi.org/10.2147/JPR.S131979

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 2

Editor who approved publication: Dr Katherine Hanlon

Jennifer M Hah,1 John A Sturgeon,1 Jennifer Zocca,2 Yasamin Sharifzadeh,3 Sean C Mackey1

1Division of Pain Medicine, 2Department of Anesthesiology, Perioperative, and Pain Medicine, 3Stanford Systems Neuroscience and Pain Lab, Stanford University, Palo Alto, CA, USA


Objective: To examine demographic features, psychosocial characteristics, pain-specific behavioral factors, substance abuse history, sleep, and indicators of overall physical function as predictors of opioid misuse in patients presenting for new patient evaluation at a tertiary pain clinic.
Methods: Overall, 625 patients with chronic non-cancer pain prospectively completed the Collaborative Health Outcomes Information Registry, assessing pain catastrophizing, National Institutes of Health Patient-Reported Outcomes Measurement Information System standardized measures (pain intensity, pain behavior, pain interference, physical function, sleep disturbance, sleep-related impairment, anger, depression, anxiety, and fatigue), and substance use history. Additional information regarding current opioid prescriptions and opioid misuse was examined through retrospective chart review.
Results: In all, 41 (6.6%) patients presented with some indication of prescription opioid misuse. In the final multivariable logistic regression model, those with a history of illicit drug use (odds ratio [OR] 5.45, 95% confidence interval [CI] 2.48–11.98, p<0.0001) and a current opioid prescription (OR 4.06, 95% CI 1.62–10.18, p=0.003) were at elevated risk for opioid misuse. Conversely, every 1-h increase in average hours of nightly sleep decreased the risk of opioid misuse by 20% (OR 0.80, 95% CI 0.66–0.97, p=0.02).
Conclusion: These findings indicate the importance of considering substance use history, current opioid prescriptions, and sleep in universal screening of patients with chronic non-cancer pain for opioid misuse. Future work should target longitudinal studies to verify the causal relationships between these variables and subsequent opioid misuse.

Keywords: sleep, pain catastrophizing, patient-reported outcomes, mood substance use

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