title: Potential risk factors associated with risk for drop-out and relapse during and following withdrawal of opioid prescription medication.
abstract: BACKGROUND
  Withdrawal of opioid medication in patients with chronic pain has a drop-out and relapse problem.
  
  
  OBJECTIVE
  To evaluate if depressive symptoms, anxiety and pain intensity are potential risk factors for drop-out or relapse during the withdrawal process. Further, to assess internal consistency of scales for assessment of these potential risk factors.
  
  
  METHODS
  Twenty-nine patients were included. After 2 years 28 of these were followed-up.
  
  
  RESULTS
  Those with depressive symptoms at baseline had a significant risk for drop-out from the withdrawal program (odds ratio 1.37) and relapse into use of opioids at follow-up (odds ratio 1.44). Drop-outs rated depressive symptoms significantly higher before detoxification. Those who relapsed rated significantly higher for pain intensity, depressive symptoms and abstinence prior to withdrawal. All scales had high reliability.
  
  
  CONCLUSIONS
  To avoid drop-out and relapse clinical practice need to screen for depressive symptoms, pain intensity, and abstinence. This article presents significant reliability of scales useful within dependency centers. They can be used to identify these risk factors for drop-out and relapse, respectively, when initiating the withdrawal process. Taking these risk factors into consideration could improve the outcome of the withdrawal process by preventing drop-out and relapse.
authors.affiliation: Karolinska Institutet, Dept. of Medicine & Dept. of Clinical Sciences, Stockholm, Sweden.
authors.forename: Susanne
authors.initials: S
authors.lastname: Heiwe
authors.forename: Ingeborg
authors.initials: I
authors.lastname: Lönnquist
authors.forename: Håkan
authors.initials: H
authors.lastname: Källmén
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D001007:Anxiety / Q000523:psychology; D059350:Chronic Pain / Q000188:drug therapy*; D003863:Depression / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010352:Patient Dropouts / Q000523:psychology*; D012008:Recurrence; D012307:Risk Factors; D013375:Substance Withdrawal Syndrome / Q000523:psychology*
chemical_list: D000701:Analgesics, Opioid