Chronic non-cancer pain is fairly common in the US. Current statistics show that it affects around 20 percent of the population. Physicians who are trying to manage the pain for their patients are using more opioids as treatment, but some pain specialists are concerned about this increased use. In order to use opioids for adequate pain control, there must be a balance between the risk factors and the need for pain relief.
Researchers did a secondary data analysis of data from the years 2000 to 2005 from regional Veterans' Affairs. The researchers wanted to identify risk factors for developing opioid abuse or dependence. Four groups of risk factors were identified and studied: non-opioid abuse disorders, painful physical health disorders, mental health disorders, and socio-demographic factors.
The sample included 15,160 chronic users of opioids, not including methadone, for chronic non-cancer pain. To determine chronic opioid use, the researchers used a cut-off point of 91 days or more for opioid use within a 12-month period. Of the sample group, 45.3 percent were diagnosed with a mental health disorder and 7.6 percent were diagnosed with non-opioid substance abuse. Sixty-eight percent of participants were diagnosed with arthritis, 53.6 percent with back pain, and 8.4 percent with headaches.
The results of the study showed that 2 percent of patients who used chronic opioids who were not abusing or were not dependent upon opioids in 2002 were clinically recognized with opioid abuse or dependence in 2003 to 2005. The researchers found that those who had abuse of other substances, other than opioids, or those who had mental disorders had a higher chance of developing the abuse or dependence.
Three percent of patients with mental disorders were found to have clinical symptoms of abuse or dependence. Younger age also played a role in abuse or dependence. The researchers also found that the more a patient was prescribed an opioid, the higher the abuse risk. For example, patients who received at least 211 days' supply were more likely to develop abuse or dependence than were those who received only a 90- or 120-day supply.
With these study findings, physicians must keep in mind the chance of abuse or dependence, but keeping opioids from patients who could be relieved from their chronic pain by holding opioids in general may be too drastic. Keeping this in mind, physicians are urged to carefully screen patients for predisposing factors that may lead to opioid abuse or dependence.
Mark J. Edlund et al. Risk factors for clinically recognized opioid abuse and dependence among veterans using opioids for chronic non-cancer pain. In Pain. June 2007. Vol. 129. No. 3. Pp. 355-363.'