To describe the characteristics of patients with chronic noncancer pain (CNCP) prescribed opioids by community physicians and referred to a tertiary pain clinic.
Cross-sectional, descriptive study.
A tertiary care, hospital-based pain clinic in Toronto, Ont.
A total of 455 consecutive patients newly referred to the pain clinic by community physicians.
Data on demographic characteristics, pain ratings, and medication intake were obtained using standardized collection forms and retrospective chart review. Patients were classified by diagnosis: group 1 patients had biomedical disorders only, group 2 patients had biomedical disorders and psychological factors, and group 3 patients had psychological factors only. Patients were also categorized based on opioid use: no opioid use (NOU); low opioid use (LOU), with a daily morphine-equivalent dosage (MED) of 200 mg or less; or high opioid use (HOU), with a daily MED of more than 200 mg.
In the general study population, 63% of patients were taking opioids, with 1 in 5 exceeding an MED of 200 mg daily. In group 1, 59% of patients used opioids and 10% had HOU; 66% of patients in groups 2 and 3 were taking opioids, with 21% and 26% classified as having HOU. The mean (SD) daily MED for groups 2 and 3 HOU patients combined was significantly higher than that of group 1 HOU patients: 575.7 (472.9) mg/d versus 284.9 (74.6) mg/d, respectively. Men were twice as likely as women to have HOU; Canadian-born patients were 3 times as likely as foreign-born patients to have HOU. Psychoactive drugs were coprescribed in 61% of LOU patients and 76% of HOU patients. Greater opioid use was associated with group 2 and 3 diagnoses, male sex, Canadian-born origin, and high pain scores.
Our results indicate that male, Canadian-born CNCP patients presenting with psychological morbidity or comorbidity and reporting higher pain severity ratings were more likely to receive opioids. Additionally, many CNCP patients referred to our tertiary care pain clinic were receiving opioids in excess of a 200-mg/d MED. More studies are needed to determine which factors lead to high-dose opioid prescribing in a subset of this CNCP population.
Cites: Arch Intern Med. 2001 Dec 10-24;161(22):2721-411732938
Cites: CMAJ. 2006 May 23;174(11):1589-9416717269
Cites: J Gen Intern Med. 2006 Jun;21(6):652-516808752
Cites: CMAJ. 2006 Nov 21;175(11):138517116905
Cites: Arthritis Rheum. 2007 Mar 15;57(2):234-917330299
Cites: Pain Res Manag. 2007 Summer;12(2):100-617505571
Cites: Ann Epidemiol. 2007 Aug;17(8):597-60217574863
Cites: J Pain. 2008 Jun;9(6):473-8618342577
Cites: Pain. 2008 Aug 31;138(2):440-918547726
Cites: Pain Res Manag. 2008 Sep-Oct;13(5):389-9418958310
Cites: Can Fam Physician. 2009 Jan;55(1):68-9, 69.e1-519155373
Cites: Pol Arch Med Wewn. 2009 Jul-Aug;119(7-8):469-7719776687