Opioid use behaviors, mental health and pain--development of a typology of chronic pain patients.
BACKGROUND
The intersection of pain, addiction and mental health has not been adequately described. We describe the roles of these three conditions in a chronic pain patient population using opioid analgesics. Aims were to improve our understanding of this population as well as to explore ways of identifying different types of patients.


METHODS
We conducted a retrospective cohort study in a large integrated group medical practice in Washington State with persons using opioids chronically (n=704). Patient classes were derived with latent class analysis using factors representing DSM-IV opioid abuse and dependence, opioid misuse, pain, anxiety and depression. Regression analyses explored the utility of automated and interview data to distinguish the empirically derived patient groups.


RESULTS
Three classes were identified: a Typical group, the substantial majority that had persistent, moderate mental health and pain symptoms; an Addictive Behaviors group with elevated mental health symptoms and opioid problems, but pain similar to the Typical class; and a Pain Dysfunction class with significantly higher pain interference as well as elevated mental health and opioid problems. Prescribed average daily dose of opioids was three times higher for those in the two atypical groups and was strongly associated with class membership after adjusting for other variables.


CONCLUSIONS
We describe three distinct types of patient classes as well as data elements that could help identify the two atypical types. Further research is needed to confirm these findings and determine the utility of this approach in other clinical settings.
Banta-Green
Caleb J
CJ
Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA 98105, USA. calebbg@u.washington.edu
Merrill
Joseph O
JO
Doyle
Suzanne R
SR
Boudreau
Denise M
DM
Calsyn
Donald A
DA
D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D001007:Anxiety / Q000523:psychology; D002908:Chronic Disease; D015331:Cohort Studies; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000145:classification* / Q000523:psychology*; D010146:Pain / Q000145:classification* / Q000188:drug therapy* / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D055815:Young Adult
D000701:Analgesics, Opioid