Pain medication beliefs and medication misuse in chronic pain.
This study assessed the influence of medication beliefs, symptom severity, disability, mood, and psychiatric history on opiate medication misuse behaviors in 288 chronic pain patients. Data were gathered by questionnaires and systematic reviews of electronic medical records. The results demonstrate that patients with a history of substance abuse, compared to those without, showed greater medication misuse despite similar dosages and self-rated opiate effectiveness. Misusers believed more strongly in the potential for opiate addiction and that they required higher doses than others, but also had greater belief in opiate effectiveness and the importance of free access. Although both anxiety and substance abuse history are related to medication misuse, a multivariate analysis indicated that these factors can be seen as mediated by medication beliefs. These data suggest important roles for historical, affective, and cognitive variables in understanding medication misuse. Patients with a history of substance abuse report stronger beliefs in opiate effectiveness while simultaneously showing awareness of their addiction potential. Providers may help patients by addressing these issues prior to prescribing opiates.


CONCLUSIONS
History of substance abuse is associated with increased opiate medication misuse independent of differences in reported opiate effectiveness. Self-attributions regarding opiate treatment related to need for higher doses, dose control, and addiction potential, may be important mediators of this relationship and interact with anxiety to produce heightened risk of opiate misuse.
Schieffer
Beatrix M
BM
Veteran's Administration Greater Los Angles Healthcare System, Los Angeles, CA 90073, USA.
Pham
Quyhn
Q
Labus
Jennifer
J
Baria
Ariel
A
Van Vort
Walter
W
Davis
Philip
P
Davis
Frederick
F
Naliboff
Bruce D
BD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D001008:Anxiety Disorders / Q000523:psychology; D001294:Attitude to Health; D015984:Causality; D015897:Comorbidity; D004305:Dose-Response Relationship, Drug; D004361:Drug Tolerance / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000523:psychology*; D009293:Opioid-Related Disorders / Q000523:psychology*; D010148:Intractable Pain / Q000188:drug therapy* / Q000523:psychology*; D011584:Psychology; D011795:Surveys and Questionnaires
D000701:Analgesics, Opioid