(36) A Nationwide Registry-Linkage Study of Mental Disorders in Chronic Pain Patients: Characteristics of Users of Opioid Versus Non-Opioid Analgesics

Sunday, August 28, 2022

8:00 AM – 1:45 PM CEST

Location: Hall C

Publication Number: 1081

Presenting Author(s)

Line C. Gjerde, PhD
– Researcher, NIPH, OSLO, Norway

Co-Author(s)

Marte Handal, MD, PhD
– Norwegian Institute of Public Health, Oslo, Norway
Ragnar Nesvåg
– Norwegian Institute of Public Health, Norway
Thomas Clausen, Prof. MD, PhD
– Professor and head of research centre, Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Norway
Torgeir G. Lid
– Research leader, Stavanger University Hospital, Stavanger, Norway
Aleksi Hamina
– University of Oslo, Oslo, Oslo, Norway
Svetlana Skurtveit
– Department of Mental Disorders, Norwegian Institute of Public Health, Norway, Oslo, Norway
Ingvild Odsbu
– Researcher, Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Oslo, Norway

Background: 30% of the Norwegian population self-report chronic pain. Individuals with chronic pain are more likely to experience mental disorders. Experiencing mental disorders is a risk factor for developing addictive behavior. Norwegian GPs and specialists can prescribe reimbursed opioid and non-opioid analgesics to chronic pain patients.

Objectives: We aimed to compare psychiatric comorbidities between chronic pain patients being prescribed opioid vs non-opioid analgesics.

Methods: Population-based cohort study. Linked data from nationwide health registers on dispensed drugs and diagnoses from primary (ICPC-2) and secondary (ICD-10) health care. All patients over 18 years of age filling at least one prescription of an analgesic reimbursed for non-malignant chronic pain in both 2018 and 2019 were included (N=139434, 69.3% women). Prevalence of mental disorders from both primary and secondary care in 2019 were calculated overall, and among patients receiving opioid versus non-opioid analgesics, according to age and gender.

Results: The overall prevalence of any mental disorder was 35.6% (95% CI 35.4-35.9). Most mental disorders were more prevalent among opioid users and among the youngest age group (18-44 years). Usually, women had higher prevalence of mental disorders than men. The highest prevalence of any mental disorder was found among 18–44-year-olds receiving reimbursed opioids (women: 55.8%; men: 50.4%). In this age group, the most frequent disorders were depressive disorders (women: opioids: 20.4% vs non-opioids 15.4%; men: 17.2% vs 11.7%), sleep disorders (women: 18.1% vs 8.8%; men 14.4% vs 11.2%), and phobia/anxiety disorders (women: 12.8% vs 8.9%; men 11.5% vs 8.4%). Alcohol and substance abuse (women: 8.5% vs 2.1%; men 10.6% vs 5.9%) and ADHD (women: 4.9% vs 3.5%; men 5.8% vs 4.5%) were also frequent in this age group.

Conclusions: Mental disorders in chronic pain patients receiving analgesics is common, particularly in young people using opioids. The combination of opioid use and high degree of psychiatric comorbidity suggests that prescribers should be aware of the potential risk of developing iatrogenic opioid use disorder especially in the youngest patients.