In individuals with chronic non-cancer pain who initiate treatment with weak or strong opioids, factors associated with higher rates of sickness absence and disability pension include a high number of comorbidities and previous psychotropic medication use, according to a study published in Pain.

The study was a retrospective analysis of Swedish individuals age 24 to 59 who started taking opioid medications in 2009. The occurrence of sickness absence >14 days and disability pension in the 5 years before and after opioid initiation (strong opioids, model 1; weak opioids, model 2) were estimated using group-based trajectory modelling.

A total of 201,641 young and middle-aged Swedish individuals (mean age, 43.2) were found to initiate opioids in 2009 (strong opioids, 6.9%). A greater percentage of individuals initiating strong vs weak opioids had previously used nonopioid analgesics (84.2% vs 63.1%, respectively) and persistent high sickness absence/disability pension (320 days/year; 12.5% vs 9.1%, respectively). A total of 72.9% of individuals initiating strong opioids had persistent low or minimum sickness absence/physical disability (estimated at 30 days/year) rates. Strong opioid initiators with persistent high sickness absence/physical disability were found to be more likely to have ≥5 comorbidities (odds ratio [OR], 8.72; 95% CI, 5.61-13.56), ≤9 years of education (OR, 5.83; 95% CI, 4.84-7.03), and a history of antidepressant (OR, 4.57; 95% CI, 3.89-5.37) and antipsychotic (OR, 4.49; 95% CI, 2.93-6.88) use.

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Factors associated with an increased sickness absence/physical disability trajectory in individuals initiating weak opioids also included having ≥5 comorbidities (OR, 3.72; 95% CI, 3.00-3.56). Previous antidepressant use (OR, 3.99; 95% CI, 3.36-4.74) and the presence of ≥5 comorbidities (OR, 4.92; 95% CI, 3.13-7.72) were associated with an increased sickness absence/physical disability trajectory in strong opioid initiators. Variables associated with a decreased sickness absence/physical disability trajectory in weak opioid initiators included previous use of antidepressants (OR, 3.73, 95% CI, 3.57-3.89) and of antipsychotics (OR, 3.39; 95% CI, 2.98-3.86) and with the presence of ≥5 comorbidities (OR, 3.84; 95% CI, 3.50-4.22).

Study limitations include its retrospective design and the sole inclusion of Swedish individuals, which may limit generalizability of the findings.

“Although we cannot exclude the possibility that opioids benefit specific patients, at a population level, opioid initiation did not seem to be associated with a change in pattern of sickness absence/physical disability,” concluded the study authors.

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Lalic S, Bell JS, Gyllensten H, et al. Trajectories of sickness absence and disability pension before and after opioid initiation for noncancer pain: a 10-year population-based study. Pain. 2019 May;160(5):1224-1233.