(108) Use of Pharmacological and Non-Pharmacological Treatments for Chronic Non-Cancer Pain Among People Using Opioids: A Longitudinal Cohort Study

Saturday, August 27, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 782

Presenting Author(s)

Ria E. Hopkins, MPH, BHS
– National Drug and Alcohol Research Centre, UNSW Sydney, UNSW Sydney, Randwick, New South Wales, Australia

Co-Author(s)

Gabrielle Campbell, BA(Psych), MCrim, PhD
– Senior Research Fellow, School of Health and Behavioural Sciences, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
Louisa Degenhardt, BA(Psych), MPsychol(Clinical), PhD
– Scientia Professor, National Drug and Alcohol Research Centre, UNSW Sydney, Randwick, New South Wales, Australia
Suzanne Nielsen, BPharmSc(Hons), PhD
– Associate Professor, Monash Addiction Research Centre, Monash University, Melbourne, Victoria, Australia
Fiona Blyth, BSc(Med), MBBS(Hons), MPH, PhD
– Associate Dean, Concord Clinical School, University of Sydney, Sydney, New South Wales, Australia
Milton Cohen, MBBS
– Specialist Pain Physician, St Vincent's Clinical School, UNSW Sydney, Sydney, New South Wales, Australia
Natasa Gisev, PhD
– University of New South Wales, Randwick, New South Wales, Australia

Background: Although multimodal management of chronic non-cancer pain (CNCP) is recommended, long-term medicine and health service utilization among people using opioids for CNCP is not well known.

Objectives: This study aimed to describe 12-month and 30-day use of medicines and health services for pain over four years; and determine associations between 30-day use and sociodemographic and pain characteristics.

Methods: The Pain and Opioids IN Treatment (POINT) study included 1514 Australian adults receiving opioids for CNCP for more than six weeks. Medicines (opioid and non-opioid analgesics, psychotropic medicines) and services (physical, mental health, specialized) used in the previous 12-months and 30-days were collected annually over four years (2015-2018). Associations were explored between 30-day treatment use and sociodemographic characteristics and pain measures using mixed-effects logistic regression models. Multiple imputation using chained equations was conducted to reduce bias from missing data.

Results: Overall, 1334 participants completed at least one annual follow-up (median age 57 years, interquartile range (IQR) 48-67, 56% female). Median pain severity (5.0, interquartile range (IQR) 3.8-6.3) and pain interference scores (5.7, IQR 3.9-7.3) indicated moderate pain throughout the study period. Most participants reported use of medicines (12-month: 97.6%; 30-day: 96.8%) and services (12-month: 91.8%; 30-day: 66.1%). Some treatment use was not consistent with guidelines: ongoing use of non-steroidal anti-inflammatory drugs and sedative-hypnotics was common, as was gabapentinoid use for non-neuropathic pain, while fewer people engaged with specialist pain management programs (12-month: 22.3%). Private health insurance was associated with using physical (adjusted odds ratio (aOR) 1.59, 99.5% confidence intervals (CI) 1.15-2.22) and specialized services (aOR 1.47, 99.5%CI 1.14-1.91), but not medicine use.

Conclusions: Many people taking opioids long-term for CNCP also use other treatments. Medicines were used more frequently and consistently than non-pharmacological treatments. Pain severity remained high, suggesting current treatment models may be insufficient, and access to effective pain management remains a significant problem for many patients.