Medication compliance in patients with chronic pain.
BACKGROUND
Despite hints about the high incidence of pain patients misreporting their pain medication use, there are only a few non-controlled studies on the topic that focus solely on opioids.


OBJECTIVE
Using toxicological analyses in a cross-sectional study, we investigated patients' reliability regarding their report of any current pain medication use.


METHODS
A cross-sectional study.


METHODS
A comprehensive pain center and a surgical unit of a German University Hospital.


METHODS
Consecutive outpatients at their first visit to the pain clinic (PG, n = 243) and pre-surgical control patients (SG, n = 100) suffering from pain reported on their current pain medication. The patients' reports were verified in serum and urine using specific toxicological methods. Two types of noncompliance were defined: under-reporting (detection of non-reported substances) and over-reporting (reported substances undetectable). The impact of clinical parameters on compliance was investigated using binary logistic regression.


RESULTS
The incidence of noncompliance was significantly higher in the PG (43.3%) than in the SG (24%; P < 0.05). Under-reporting occurred similarly in both groups (31% PG; 23% SG), whereas over-reporting predominantly appeared in the PG (11% vs. 2%; P < 0.05). Opioids were not most frequently under-reported, but the highest proportion of under-reported drugs (under-reported in relation to detection incidence) was found for non-opioid analgesics (NSAIDs: 29% PG; 25% SG; other: 42% PG; 32% SG) and psychotropic drugs (35% PG; 53% SG). In the PG, logistic regression revealed high depression scores to be predictive for noncompliance (odds ratio 2.12).


CONCLUSIONS
Due to lack of a structured follow-up interview motives of under- and over-reporting stay speculative.


CONCLUSIONS
Under-reporting of non-opioid analgesics is the main type of noncompliance, a disquieting fact in light of their toxicity and adverse effects. Further research is required in terms of drug assessment and compliance improvement strategies in pain clinics; therefore, toxicological monitoring is indispensable.


BACKGROUND
NCT01625065; Medi-3889-10.
Department of Pain Management, BG Universitatsklinikum Bergmannsheil GmbH, Ruhr University Bochum, Germany.
Katherina
K
Kipping
Christoph
C
Maier
Heinz H
HH
Bussemas
Andreas
A
Schwarzer
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000097:blood / Q000627:therapeutic use / Q000652:urine; D059350:Chronic Pain / Q000097:blood / Q000523:psychology* / Q000628:therapy* / Q000652:urine; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018710:Pain Clinics; D010147:Pain Measurement; D010349:Patient Compliance / Q000523:psychology*; D015203:Reproducibility of Results; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D055815:Young Adult
D000700:Analgesics