Patients on long-term opioid treatment for chronic pain reported experiencing negative physical side effects, emotional distress, and degraded relationships with their primary care provider, according to interview results published in the International Journal of Drug Policy.
To examine the impact of widespread efforts to curb the health crisis related to opioid treatment in the United States, researchers conducted interviews with 97 patients with chronic pain (mean age, 61.3 years) who were closely monitored by their primary care providers to lower dosages or taper off opioid medications.
Participants were assigned to the usual care arm of the Pain Program for Active Coping and Training study. The most frequent chronic pain diagnoses in this cohort were back and/or neck pain, fibromyalgia and/or widespread muscle pain, limb or extremity pain, joint pain, and arthritic disorders. The interviews highlighted 3 interconnected themes capturing the effects of chronic opioid therapy.
Although patients tended to believe that opioid treatment helped manage their chronic pain, they also reported experiencing debilitating physical adverse events such as difficulty sleeping and an inability to think clearly.
Some patients reported experiencing significant emotional distress related to opioid use. Many participants believed that stricter prescription regulations would limit their access to vital pain relief and hinder their well-being. Some patients sought mental health counseling to deal with the social stigma associated with opioid use or the emotional burden related to the reliance on medication for their well-being.
Participants also often reported the relationship with their primary care provider to be hampered as a result of negotiations concerning tapering or ceasing opioid treatment. Of the patients, 1 reported feeling angry with her physician for “enforcing a required opioid agreement,” and another felt his physician viewed him as a potential opioid abuser rather than an individual.
Study limitations include the fact that data was obtained from a single delivery system, thus limiting generalization of the findings.
“In addition to known side effects, patients also experience the burden of public discourse and associated institutional changes in opioid prescriptions as extremely stressful, placing a burden on their emotional health and relationships with their primary care providers, noted the study authors. “ Chronic pain is a biopsychosocial phenomenon, requiring multi-faceted approaches and solutions.”
Gruß I, Firemark A, et al. Taking opioids in times of crisis: Institutional oversight, chronic pain and suffering in an integrated healthcare delivery system in the U.S. [published online September 16, 2019]. Int J Drug Policy. doi:10.1016/j.drugpo.2019.08.009