Background: There is general agreement about the need toperform a screening test to assess the risk of opioid misuseprior to starting a long-term opioid treatment for chronicnoncancer pain. The evidence supporting the effectiveness ofopioid long-term treatment is weak, and no predictors of itsusefulness have been assessed.Objective: The aim of this study was to assess the effect onpain and quality of life of chronic opioid treatment, anddetect the possible predictors of its effectiveness.Methods: This observational, prospective study was con-ducted in 2 Italian Pain Relief Units on 77 patients affected byintractable chronic pain. Patients were submitted to psycho-logical tests, investigating the individual pain experience, riskof opioid misuse, mood states, quality of life, and personalitycharacteristics prior to starting treatment and at 2,4, and6-month follow-up.Results: Both maximum and habitual pain, as measuredwith VAS, underwent a statistically significant reduction at 2,4, and 6-month follow-up. In multivariate analysis, lowerscores in the Pain Medication Questionnaire (PMQ) werepredictive of a major reduction in maximum VAS (P = 0.005).Both low PMQ and MMPI-cynicism scores were predictive ofhabitual VAS decrease (P = 0.012 and P = 0.028, respectively).Conclusion: The results indicate that pain relief signifi-cantly improved over a 6-month period of opioid treat-ment, together with quality of life. The outcome wasbetter in patients with a pretreatment low risk of opioidmisuse, low scores in the Cynicism scale of MMPI-2, and noaberrant drug behaviors at follow-up. Therefore, a psy-chological screening and support is crucial for a goodoutcome of opioid therapy for chronic noncancer painpatients.
Effectiveness of opioid analgesics in chronic non cancer pain.
ZANOLIN, Maria Elisabetta;
2015
Abstract
Background: There is general agreement about the need toperform a screening test to assess the risk of opioid misuseprior to starting a long-term opioid treatment for chronicnoncancer pain. The evidence supporting the effectiveness ofopioid long-term treatment is weak, and no predictors of itsusefulness have been assessed.Objective: The aim of this study was to assess the effect onpain and quality of life of chronic opioid treatment, anddetect the possible predictors of its effectiveness.Methods: This observational, prospective study was con-ducted in 2 Italian Pain Relief Units on 77 patients affected byintractable chronic pain. Patients were submitted to psycho-logical tests, investigating the individual pain experience, riskof opioid misuse, mood states, quality of life, and personalitycharacteristics prior to starting treatment and at 2,4, and6-month follow-up.Results: Both maximum and habitual pain, as measuredwith VAS, underwent a statistically significant reduction at 2,4, and 6-month follow-up. In multivariate analysis, lowerscores in the Pain Medication Questionnaire (PMQ) werepredictive of a major reduction in maximum VAS (P = 0.005).Both low PMQ and MMPI-cynicism scores were predictive ofhabitual VAS decrease (P = 0.012 and P = 0.028, respectively).Conclusion: The results indicate that pain relief signifi-cantly improved over a 6-month period of opioid treat-ment, together with quality of life. The outcome wasbetter in patients with a pretreatment low risk of opioidmisuse, low scores in the Cynicism scale of MMPI-2, and noaberrant drug behaviors at follow-up. Therefore, a psy-chological screening and support is crucial for a goodoutcome of opioid therapy for chronic noncancer painpatients.
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