Opiates for chronic nonmalignant pain syndromes: can appropriate candidates be identified for outpatient clinic management?
OBJECTIVE
To better define patients appropriate for opiate management for chronic pain syndromes.


METHODS
Retrospective study of 65 patients with noncancerous pain syndromes who were on or being considered for opiates and who were transitioned into a structured outpatient clinic with close monitoring and management. Noncompliance with this outpatient pain management program was the primary outcome. Noncompliance was defined as (1) receipt of prescriptions from providers outside of this clinic, (2) increase in medication dosage without proper approval, (3) refusing toxicology screening on entrance into the program, (4) negative toxicology tests for prescribed medications, (5) positive toxicology tests for psychoactive medications not prescribed, or (6) discovery on toxicology tests of the presence of illicit substances.


RESULTS
There were 24 cases of noncompliance (37%), with age <56 yrs old demonstrating significant (P = 0.02) association with persons who were noncompliant with the outpatient program. Forty-three percent of those younger than 56 yrs were noncompliant with program, yet no patient older than 56 yrs was noncompliant. Working status approached significance (P = 0.07) with those patients out of work demonstrating a greater likelihood of noncompliance. There were no correlations found between other patient characteristics and the level of compliance with the program.


CONCLUSIONS
When considering opiates as a treatment option, pain clinics should have a heightened suspicion for younger and unemployed patients. Although these findings should be examined in larger studies, they suggest that nonmedical factors play a substantial role regarding success in such a structured opiate pain program.
Department of Physical Medicine and Rehabilitation, the Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA.
Kevin T
KT
White
Timothy R
TR
Dillingham
Marlís
M
González-Fernández
Linda
L
Rothfield
D000328:Adult; D000367:Age Factors; D000368:Aged; D000554:Ambulatory Care Facilities; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002908:Chronic Disease / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000517:prevention & control; D010146:Pain / Q000188:drug therapy*; D018710:Pain Clinics; D018579:Patient Selection; D012307:Risk Factors; D014478:Unemployment; D055815:Young Adult
D000701:Analgesics, Opioid