Patient experience with long-term opioids for chronic pain

BACKGROUND: The treatment of noncancer chronic pain (NCCP) with opioids has become popular, but knowledge of long-term effectiveness and adverse effects is limited. Investigations of self-reported experiences with pain and opioids over long periods may increase our understanding of the benefits and risks of long-term opioid therapy.

METHODS: All patients 18+ years in two primary care practices who had been prescribed opioids for NCCP continuously for 1 year or more were identified (n=182). A survey about their experience with NCCP and opioids was mailed to a systematic sample stratified by provider (n=107). The survey included items on pain characteristics and treatments, opioid use, response, and adverse effects, and physical function. Subjects were also asked to participate in a telephone interview about their opioid experiences and to approve access to their medical records.

RESULTS: 46 surveys were returned (44% response rate), 42 patients were interviewed, and 35 medical records were abstracted. 90% of patients reported lower back pain (76% for 5+ years), 37% reported fibromyalgia, and > 60% reported hip and/or knee pain. 61% reported taking long and short acting opioids; 33% had started daily opioids 10+ years ago. On a scale from 0-10, 77% reported an average pain intensity of 6-8, 11% a level of 9-10. 28% rated opioids ‘very effective' and 67% ‘somewhat effective' in controlling pain. 74% reported opioids improved their ability to perform moderate activities. 87% agreed the benefits of opioids outweighed negative effects. Respondents reported several adverse opioid effects occurring ‘sometimes' or ‘often': constipation (59%), drowsiness (58%), fatigue (50%), sweating (46%), and nausea (30%). In interviews, a majority stated that relief from pain was the first thing about opioids that came to mind; most acknowledged improved quality of life related to opioids; and many reported negative opioid-related experiences including discomfort with the need for opioids and fear of addiction.

CONCLUSION: Qualitative and quantitative analyses confirm that most patients with NCCP receiving opioids credit them with providing several important benefits, but by several measures the perceived effectiveness of opioids varies widely. Adverse effects from, and negative attitudes about, opioids are common. Modifications of opioid type and dose and patient education have potential for reducing negative experiences with opioids and improving pain control in the primary care setting. This study raises interesting questions about measuring and interpreting variations in opioid prescribing and the need for larger studies aimed at providing more objective evidence of long-term opioid effectiveness.