Addressing Opioid-Related Chemical Coping in Long-Term Opioid Therapy for Chronic Noncancer Pain: A Multicenter, Observational, Cross-Sectional Study.

Anyela Castañeda,Jee Moon,Dasom Lee,Chang-Soon Lee,Yong-Chul Kim

doi:10.3390/jcm7100354

Anyela Castañeda, Jee Moon + Show 3 more

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https://doi.org/10.3390/jcm7100354

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Abstract

Opioid consumption has increased worldwide, which carries the risk of opioid use disorder (OUD). However, the literature on OUD and opioid-related chemical coping (OrCC) in chronic noncancer pain (CNCP) is heterogeneous, with most studies conducted in the United States. We performed a multicenter, observational, cross-sectional study to address OrCC in long-term opioid therapy (LtOT) for CNCP in South Korea. The objectives were to determine the frequency and predictors of OrCC. We included 258 patients. Among them, fifty-five (21%) patients showed OrCC. The sample had high pain catastrophizing (≥30 points; 66%), moderate-severe insomnia (≥15 points; 63%), low resilience (68 points), and high suicidal ideation (67%). OrCC patients had greater pain interference (85.18% vs. 58.28%, p = 0.017) and lower satisfaction with the LtOT (56.4% vs. 78.3%, p = 0.002). In multivariable analysis, alcohol abuse (OR = 6.84, p = 0.001), prescription drugs abuse (OR = 19.32, p = 0.016), functional pain (OR = 12.96, p < 0.001), head and neck pain (OR = 2.48, p = 0.039), MEDD (morphine equivalent daily dose) ≥ 200 mg/day (OR = 3.48, p = 0.006), and ongoing litigation (OR = 2.33, p = 0.047) were significant predictors of OrCC. In conclusion, the break-out of OrCC in CNCP in South Korea was comparable to those in countries with high opioid consumption, such as the United States, regardless of the country’s opioid consumption rate.

Highlights

Chronic pain is a devastating disease that is often treated inadequately [1]
* The presence of opioid-related chemical coping (OrCC) was evaluated by a physician, using a questionnaire that contained seven behaviors related to OrCC
Two or more affirmative answers to the questionnaire were considered positive for OrCC. † Satisfied = extremely satisfied and somewhat satisfied, unsatisfied = somewhat unsatisfied and extremely unsatisfied; Brief Pain Inventory-Short Form (BPI-SF), brief pain inventory-short form; CAGE-AID, cut down, annoyed, guilty, eye-opener—adapted to include drugs; Hospital Anxiety and Depression Scale (HADS), hospital anxiety and depression scale; Insomnia Severity Index (ISI), insomnia severity index; Korean Instrumental Activities of Daily Living Scale (K-IADL), Korean-instrumental activities of daily living; K-CD-RISC, Korean-Connor-Davidson resilience scale; Pain Catastrophizing Scale (PCS), pain catastrophizing scale; Patient Global Impression of Change Scale (PGIC), patient global impression of change; SD, standard deviation

Summary

Introduction

Among a plethora of treatments, opioid agonists are one pharmacotherapy for moderate-severe pain. Its consumption by country (mg/capita) has increased in the last two decades [2,3,4], it may remain under-requirements for managing moderate-severe pain in some regions, including Asian countries [1,4,5]. Korea), it was 55 mg/capita which was below average, ranking 43rd globally and 30th among thirty-five Organisation for Economic. Cooperation and Development (OECD) countries (258 mg/capita average in OECD countries) [4]. It is remarkable that the opioid consumption in S. Korea has increased 5–6 times since 2005 (10 mg/capita), ranking 3rd among Asian countries preceded only by Vietnam (62 mg/capita) and Malaysia (60 mg/capita)

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