title: Chronic pain and use of opioids: a population-based pharmacoepidemiological study from the Norwegian prescription database and the Nord-Trøndelag health study.
abstract: In previous studies on prescription patterns of opioids, accurate data on pain are missing, and previous epidemiological studies of pain lack accurate data on opioid use. The present linkage study, which investigates the relationship between pain and opioid use, is based on accurate individual data from the complete national Norwegian prescription database and the Nord-Trøndelag health study 3, which includes about 46,000 people. Baseline data were collected in 2006 to 2008, and the cohort was followed up for 3 years. Of 14,477 people who reported chronic nonmalignant pain, 85% did not use opioids at all, 3% used opioids persistently, and 12% used opioids occasionally. Even in the group reporting severe or very severe chronic pain, the number not using opioids (2680) was far higher than the number who used opioids persistently (304). However, three quarters of people using opioids persistently reported strong or very strong pain in spite of the medication. Risk factors for the people with chronic pain who were not persistent opioid users at baseline to use opioids persistently 3 years later were occasional use of opioids, prescription of >100 defined daily doses per year of benzodiazepines, physical inactivity, reports of strong pain intensity, and prescription of drugs from 8 or more Anatomical Therapeutic Chemical groups. The study showed that most people having chronic nonmalignant pain are not using opioids, even if the pain is strong or very strong. However, the vast majority of patients with persistent opioid use report strong or very strong pain in spite of opioid treatment.
authors.affiliation: Pain and Palliation Research Group, Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway National Competence Centre for Complex Symptom Disorders, Department of Pain and Complex Disorders, St. Olav University Hospital, Trondheim, Norway Centre of Palliative Medicine, Surgical Division, Akershus University Hospital, Lørenskog, Norway Department of Pharmacoepidemiology, Division of Epidemiology, The Norwegian Institute of Public Health, Oslo, Norway Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway Department of Emergency Medicine, St. Olav University Hospital, Trondheim, Norway Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Olav Magnus S
authors.initials: OMS
authors.lastname: Fredheim
authors.forename: Milada
authors.initials: M
authors.lastname: Mahic
authors.forename: Svetlana
authors.initials: S
authors.lastname: Skurtveit
authors.forename: Ola
authors.initials: O
authors.lastname: Dale
authors.forename: Pål
authors.initials: P
authors.lastname: Romundstad
authors.forename: Petter C
authors.initials: PC
authors.lastname: Borchgrevink
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use*; D059350:Chronic Pain / Q000188:drug therapy*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009664:Norway; D010147:Pain Measurement; D017891:Pharmacoepidemiology; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D000701:Analgesics, Opioid; D001569:Benzodiazepines
keywords: Chronic nonmalignant pain; Epidemiology; HUNT; Opioid; Pharmacoepidemiology