title: Effect of chronic opioid therapy on actual driving performance in non-cancer pain patients.
abstract: Chronic non-cancer pain (CNCP) is a major health problem. Patients are increasingly treated with chronic opioid therapy (COT). Several laboratory studies have demonstrated that long-term use of opioids does not generally impair driving related skills. But there is still a lack of studies investigating on-the-road driving performance in actual traffic.
  
  
  
  The present study assessed the impact of COT on road-tracking and car-following performance in CNCP patients.
  
  
  
  Twenty CNCP patients, long-term treated with stable doses of opioid analgesics, and 19 healthy controls conducted standardized on-the-road driving tests in normal traffic. Performance of controls with a blood alcohol concentration (BAC) of 0.5 g/L was used as a reference to define clinically relevant changes in driving performance.
  
  
  
  Standard Deviation of Lateral Position (SDLP), a measure of road-tracking control, was 2.57 cm greater in CNCP patients than in sober controls. This difference failed to reach statistical significance in a superiority test. Equivalence testing indicated that the 95% CI around the mean SDLP change was equivalent to the SDLP change seen in controls with a BAC of 0.5 g/L and did not include zero. When corrected for age differences between groups the 95% CI widened to include both the alcohol reference criterion and zero. No difference was found in car-following performance.
  
  
  
  Driving performance of CNCP patients did not significantly differ from that of controls due to large inter-individual variations. Hence in clinical practice determination of fitness to drive of CNCP patients who receive opioid treatments should be based on an individual assessment.
authors.affiliation: Federal Highway Research Institute (BASt), Bruederstrasse 53, D-51427, Bergisch Gladbach, Germany. schumacher@bast.de.
authors.forename: Markus B
authors.initials: MB
authors.lastname: Schumacher
authors.affiliation: Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Universiteitssingel 40, Maastricht, 6200 MD, The Netherlands.
authors.forename: Stefan
authors.initials: S
authors.lastname: Jongen
authors.affiliation: Federal Highway Research Institute (BASt), Bruederstrasse 53, D-51427, Bergisch Gladbach, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Knoche
authors.affiliation: Universitaetsmedizin Goettingen, Georg-August-Universitaet, Robert-Koch-Str. 40, D-37075, Goettingen, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Petzke
authors.affiliation: Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Universiteitssingel 40, Maastricht, 6200 MD, The Netherlands.
authors.forename: Eric F
authors.initials: EF
authors.lastname: Vuurman
authors.affiliation: Institut für Psychologie, Ingenieur- und Verkehrspsychologie, Technische Universitaet Braunschweig, Gaussstr. 23, D-38106, Braunschweig, Germany.
authors.forename: Mark
authors.initials: M
authors.lastname: Vollrath
authors.affiliation: Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Universiteitssingel 40, Maastricht, 6200 MD, The Netherlands.
authors.forename: Johannes G
authors.initials: JG
authors.lastname: Ramaekers
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D001334:Automobile Driving; D000067401:Blood Alcohol Content; D016022:Case-Control Studies; D002492:Central Nervous System Depressants / Q000494:pharmacology; D059350:Chronic Pain / Q000188:drug therapy*; D000066448:Driving Under the Influence; D000431:Ethanol / Q000494:pharmacology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011597:Psychomotor Performance / Q000187:drug effects
chemical_list: D000701:Analgesics, Opioid; D000067401:Blood Alcohol Content; D002492:Central Nervous System Depressants; D000431:Ethanol
keywords: Chronic pain; On-the-road driving test; Opioids; SDLP