Pain Interference Associated With Depression, Pain Self-Efficacy in Chronic Musculoskeletal Pain

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Investigators enrolled 189 patients with chronic musculoskeletal pain on long-term opioid therapy and reporting severe pain intensity.
Investigators enrolled 189 patients with chronic musculoskeletal pain on long-term opioid therapy and reporting severe pain intensity.

Patients with chronic musculoskeletal pain on long-term opioid therapy who report high levels of pain may be more likely to have moderate to high pain interference, according to a study published in the Journal of Pain. In addition, high pain interference was found to be associated with higher depression severity and lower pain self-efficacy.

Investigators enrolled 189 patients with chronic musculoskeletal pain on long-term opioid therapy and reporting severe pain intensity, as defined by a score of ≥70 on the Chronic Pain Grade questionnaire.

Pain -interference — defined as the average rating for responses regarding challenges in performing daily, social, or work-related tasks — ability to cope with chronic pain,  depressive symptoms, and alcohol use were assessed.

High pain interference was reported by 44.4% of the cohort. The average daily opioid dose was comparable in patients reporting low (n=31; 16.4%), moderate (n=74; 39.2%), and high (n=84; 44.4%) pain interference. Study participants with low or moderate vs high pain interference had milder depression symptoms (assessed with the 8-item Patient Health Questionnaire; low pain interference, 7.8 and moderate, 10.4 vs high, 13.1; P <.05) and lower pain catastrophizing scores (assessed with the Pain Catastrophizing Scale; low pain interference, 13.5 and moderate, 16.9 vs high, 21.4; P <.05).

In addition, study participants with low or moderate vs high pain interference reported greater quality of life and better ability to cope with pain. Every unit increase in depression score and pain self-efficacy reduced and increased the odds of having low vs high pain interference, respectively (odds ratio [OR], 0.90; 95% CI, 0.82-0.99 and OR=1.07; 95% CI, 1.02-1.12, respectively).

The cross-sectional design of the study limits causal inferences and the lack of a comparison group further limits the analysis.

“As commonly-used medications for chronic pain often yield limited benefit in reducing pain intensity, clinicians may increasingly consider treatments that affect pain-related function and quality of life,” concluded the study investigators.

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Reference

Adams MH, Dobscha SK, Smith NX, et al. Prevalence and correlates of low pain interference among patients with high pain intensity who are prescribed long-term opioid therapy [published online April 26, 2018]. J Pain. doi:10.1016/j.jpain.2018.04.005

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