The Initiation of Chronic Opioids: A Survey of Chronic Pain Patients

In The Journal of Pain, Catherine Callinan and colleagues, including Mark Neuman and Michael Ashburn, examine the connection between reasons for opioid initiation and risk factors for chronic usage. The investigators interviewed participants who received opioid therapy for more than 90 days, and who had a non-cancer pain diagnosis. They asked them about reason for opioid initiation, original intent of prescription, length of time on opioids, and demographic data including co-morbidities. Many patients who initiated opioid therapy after surgery experienced postoperative complications, and many with injury-related pain reported follow-up corrective surgery, both of which led to prolonged continuation of opioids. Those who did not have an injury or surgery began opioid use due to a chronic disease, such as degenerative disc disease, or neuropathic pain from diabetes and HIV, despite the fact that opioids have not been shown to manage pain in these conditions. Over half of participants reported having mental health diagnoses, including depression and anxiety, a risk factor for opioid misuse. Finally, the researchers found that more than a third of participants progressed from acute to chronic opioid usage, with 23 percent of patients reporting taking chronic opioids for a different indication than originally prescribed. These findings suggest that post-surgery pain management and injury treatment are opportunities for interventions targeted at provider behavior and patient education surrounding opioid use.