Abstract
Background/Aims Chronic pain patients on prescription opioids are thought to be at risk for multiple co-morbidities, including mood and anxiety disorders, which can complicate patient care.
Methods We undertook a phone survey of 705 chronic pain patients on prescription opioids at Geisinger Clinic, a large multi-specialty practice located in central PA, to assess this potential problem. Patients who had received 5+ orders for opioids in the past 12 months for non-cancer pain were eligible for study interviews. Mental disorders were identified using a diagnostic survey that utilized Diagnostic and Statistical Manual of Mental Disorder, Version IV, criteria for generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD), major depression (MD), and prescription opioid dependence (POD). The study also collected demographic, environmental, and other health status data. Functional pain impairment was assessed using the Brief Pain Inventory (BPI).
Findings Altogether, 37% (95% CI = 33–41%) of study patients met lifetime criteria for POD, 15% (95% CI = 12–18%) for PTSD, 13% (95% CI = 11–17%) for GAD, and 38% (95% CI = 34–42%) met lifetime criteria for MD. In addition, 27% (95% CI = 24–31%) of these pain patients had a history of suicidal thoughts. Controlling for potential confounders, including gender, age, cigarette pack-years, obesity, and the presence of other mental disorders, GAD was significantly associated with greater pain impairment (p=0.01), higher service utilization (p<0.001), history of suicidal thoughts, (p=0.001), and poorer reported health status (p=0.008). Similarly, MD was significantly associated with history of suicidal thoughts, (p<0.001), poorer reported health status (p=0.037), and history of substance abuse treatment (p=0.002). PTSD and POD were not associated with these adverse outcomes, once GAD and MD were controlled.
Discussion Chronic pain patients receiving opioids have a significant history of mental health disorders, including GAD and MD and these comorbidities are associated with increased pain impairment, higher service utilization, suicidal thoughts, and poorer health status, potentially complicating patient care. Our study suggests that chronic pain patients on opioid therapy may benefit by the better integration of mental health services into both primary and specialty care services.
