Discrepancies between perceived benefit of opioids and self-reported patient outcomes

Abstract

Objective. There is little empirical evidence supporting the long-term use of opioid therapy for chronic pain, suggesting the need to reevaluate the role of opioids in chronic pain management. Few studies have considered opioid use and opioid cessation from the perspective of the patient. Methods. This prospective structured interview study included 150 new patients seeking treatment for chronic pain at an outpatient tertiary care pain clinic. Results. Of the 150 patients, 56% (N=84) reported current opioid use. Opioids users reported higher pain severity (t(137) =-3.75, P< 0.001), worse physical functioning (t(136) =-3.82, P< 0.001), and more symptoms of depression (t(136) =-1.98, P=0.050) than nonusers. Among opioid users, 45.6% reported high pain (>7), 60.8% reported low functioning (>7), and 71.4% reported less than a 30% reduction in pain severity since starting opioids, suggesting that many patients are unlikely to be receiving adequate benefit. Overall, 66.3% of current opioid users reported moderate to high opioid-related difficulties on the prescribed opioids difficulties scale, and patients with depression were more likely to report greater difficulties. There was no association between helpfulness of opioids over the past month and opioid-related difficulties (r(75)=-0.07, P=0.559), current pain severity (r(72) =0.05, P=0.705), or current pain interference (r(72) =0.20, P=0.095). Conclusions. Despite clinical indicators that question the benefit, patients may continue to report that their opioids are helpful. Such discrepancies in patients' perceptions will likely pose significant barriers for implementing opioid cessation guidelines in clinical practice.