Depression and ambivalence toward chronic opioid therapy for chronic noncancer pain.
OBJECTIVE
Chronic opioid therapy (COT) for chronic noncancer pain (CNCP) is characterized by both high rates of patient-initiated discontinuation and by perceived helpfulness among those who sustain opioid use. This study examines predictors of the desire to cut down or stop opioid therapy among patients receiving COT who report that opioids are helpful for relieving pain.


METHODS
We conducted a cross-sectional survey of 1737 selected patients receiving COT for CNCP who perceived opioids to be helpful in relieving their pain. Ambivalence about opioid use was assessed by agreement/disagreement with a statement indicating that they would like to stop or cut down the use of prescribed opioid medications. Depression was measured with the 8-item Patient Health Questionnaire.


RESULTS
A high percentage (43.3%) of survey respondents who found opioids helpful also reported the desire to stop or cut down opioids. Half of these patients reporting the desire to stop or cut down were clinically depressed, compared with a third of those not wanting to stop or cut down, a highly significant difference after controlling for covariates (P<0.0001). The group wanting to stop or cut down opioid use also reported significantly higher levels of opioid-related psychosocial problems and opioid control concerns.


CONCLUSIONS
There are high rates of ambivalence about opioid use among COT recipients who consider opioids helpful for pain relief. Depressed patients are more likely to be ambivalent about use of prescribed opioids. Eliciting patient ambivalence may be helpful in patients who are not benefiting from long-term opioid use as an initial step toward consideration of discontinuation.
Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, 98195, USA. cqhowe@uw.edu
Catherine Q
CQ
Howe
Mark D
MD
Sullivan
Kathleen W
KW
Saunders
Joseph O
JO
Merrill
Caleb J
CJ
Banta-Green
Constance
C
Weisner
Cynthia I
CI
Campbell
Michael
M
Von Korff
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D059350:Chronic Pain / Q000150:complications / Q000188:drug therapy / Q000523:psychology; D003430:Cross-Sectional Studies; D003863:Depression / Q000188:drug therapy / Q000209:etiology* / Q000523:psychology; D005260:Female; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009042:Motivation / Q000502:physiology; D010147:Pain Measurement; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013689:Telephone; D055815:Young Adult
D000700:Analgesics; D000701:Analgesics, Opioid