Opioid Analgesics Linked With Higher Rates of Unemployment in Chronic Pain

Patients taking opioid analgesics for chronic noncancer pain may have a risk for unemployment 3-fold higher compared with individuals not taking opioids.

Patients taking opioid analgesics for chronic noncancer pain may have a risk for unemployment 3-fold higher compared with individuals not taking opioids, according to a study published in Pain Medicine.

This cross-sectional, observational study included 604 participants with chronic back, osteoarthritis, or neck pain. The Acupuncture Approaches to Decrease Disparities in Pain Treatment 2-arm trial was used to collect survey data. Data on employment, use of opioids to treat pain, quality of life, pain, patient health, and demographics were collected through a survey administered at baseline. The relationship between unemployment and opioid use was analyzed through multivariable logistic regression.

Study participants using opioid analgesics (n=136) were found to be 3.08 times more likely to be unemployed due to disability than nonusers (P <.001), after adjusting for potential confounding factors (ie, depression, pain interference, demographics, global functioning, and pain intensity). In addition, opioid users were more likely than nonusers to be men vs women (25.0% vs 17.1%, respectively; P =.04), to be born in the United States vs abroad (64.7% vs 46.8%, respectively; P =.002), and to be native vs non-native English speaking (84.3% vs 76.6%, respectively; P =.02). 

No association was established between opioid use and race or ethnicity. Mental health was poorer in opioid users vs nonusers (9.91 vs 11.66, respectively on the PROMIS Global Health measure; P <.001), as was global physical health (8.98 vs 10.13, respectively; P <.001). More depression symptoms, as assessed with the Patient Health Questionnaire-9, were associated with opioid use (11.31 vs 8.65, respectively; P <.001). Pain interference was found to be higher in opioid users vs nonusers (7.30 vs 6.07, respectively; P <.001), with comparable levels of pain intensity at baseline between the 2 groups (7.22 vs 6.89, respectively; P >.05).

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The authors conclude that “opioid analgesic use was associated with 3 times the odds of unemployment due to disability…These findings are troublesome given the high prevalence of opioid prescribing among disabled Medicare and Medicaid beneficiaries. Future large-scale prospective studies that follow patients from the initiation of opioid analgesic use should be undertaken to evaluate long-term functional and employment outcomes over time. Nonetheless, this study adds to the growing body of evidence that opioid analgesics should be used with caution in chronic nonmalignant pain.”

This study received financial support from the New York State Empire Clinical Research Investigator Program and the Patient-Centered Outcomes Research Institute (AD-1402-10857).

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Chuang E, Gil EN, Gao Q, Kligler B, McKee MD. Relationship between opioid analgesic prescription and unemployment in patients seeking acupuncture for chronic pain in urban primary care [published online September 3, 2018]. Pain Med. doi: 10.1093/pm/pny169.