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
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
This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.Download Article [PDF] View Full Text [HTML][Machine readable]