title: Polypharmacy and chronic pain: harm exposure is not all about the opioids.
abstract: OBJECTIVE
  Individuals seeking treatment for chronic pain in multidisciplinary pain management services are typically already on high doses of pain medications. This cross-sectional cohort study of patients with long-term chronic pain examined profiles of polypharmacy and pain medication-related harm exposure.
  
  
  METHODS
  Multidisciplinary pain management service.
  
  
  METHODS
  The cohort comprised 224 patients taking medications for their pain (1-9 medications; mean = 3.19) with an average pain duration of 10.33 years.
  
  
  METHODS
  The Medication Quantification Scale III (MQS-III) was used to examine potential harm exposure. We generated detriment scores for simple analgesics, adjunctive therapies (e.g., anticonvulsants), opioids, and benzodiazepines.
  
  
  RESULTS
  The total MQS-III score was correlated with the total number of medications, but not with age. Almost 10% of patients took medications from all four categories, with most taking medications from two (37%) to three (35%) classes. Eighty percent of patients were taking opioids, accounting for 41% of total MQS scores. Five primary profiles of potential medication-related harms were identified: high harm from all medication categories (N = 12); above average harm from single category-simple analgesics (N = 76), adjunctive analgesics (N = 59), or opioids (N = 46); and above average opioid and benzodiazepine harm (N = 31).
  
  
  CONCLUSIONS
  While treatment with multiple medications for synergistic or adjunctive effects may assist in medical management of chronic pain, this approach generates increased potential harm exposure. We show that the majority of detriment comes from medications other than opioids and highlight the importance of profiling all pain medications contributing to polypharmacy in clinical pain studies.
authors.affiliation: School of Psychological Science, Monash University, Clayton, Victoria, Australia; Caulfield Pain Management & Research Centre, Caulfield Hospital, Caulfield, Victoria, Australia.
authors.forename: Melita J
authors.initials: MJ
authors.lastname: Giummarra
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Gibson
authors.forename: Amy R
authors.initials: AR
authors.lastname: Allen
authors.forename: Anne Sophie
authors.initials: AS
authors.lastname: Pichler
authors.forename: Carolyn A
authors.initials: CA
authors.lastname: Arnold
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects; D059350:Chronic Pain / Q000175:diagnosis* / Q000188:drug therapy*; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000379:methods; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D019338:Polypharmacy
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D000927:Anticonvulsants
keywords: Analgesia; Chronic Pain; Detriment; Harm; Opioids; Polypharmacy; Risk