Sex and Age Differences in Global Pain Status Among Patients Using Opioids Long Term for Chronic Noncancer Pain
AUTHORS: LeResche Linda, Saunders Kathleen, Dublin Sascha, Thielke Stephen, Merrill Joseph O., Shortreed Susan M., Campbell Cynthia, and Von Korff Michael R.. Journal of Women’s Health. August 2015, 24(8): 629-635. doi:10.1089/jwh.2015.5222.
Background: The use of chronic opioid therapy (COT) has risen dramatically in recent years, especially among women. However, little is known about factors influencing overall pain and function (global pain status) among COT users. Characterizing the typical experiences of COT patients by age–sex group could help clinicians and patients better weigh the risks and benefits of COT. Thus, we sought to characterize global pain status among COT users in community practice by age and sex.
Methods: Telephone survey of 2,163 health plan members aged 21–80 years using COT. We assessed average/usual pain (0–10 scale); pain-related interference (0–10); activity limitation days, last 3 months; and pain impact, last 2 weeks (0–11). Status on each indicator was classified as low (better pain/function), moderate, or high (worse pain/function). Global pain status was categorized as favorable if 2–4 indicators were low and 0–1 was high and unfavorable if 2–4 indicators were high and 0–1 was low.
Results: Among female COT patients, 15% (vs. 26% of males) had favorable global pain status and 59% (vs. 42% of males) had unfavorable status. Under age 65 years, women fared more poorly than men on every indicator. Among 65- to 80-year-olds, women and men had similar global pain status.
Conclusions: Although pain and function among COT users vary considerably, only one in five reported low pain levels and high levels of function. Young and middle-aged women seem to be at particularly high risk for unfavorable global pain status. More research is needed about how to best manage pain in this group.
Clinicians and patients with chronic pain are faced with deciding among treatment options, including long-term use of opioids, with inadequate evidence from randomized clinical trials regarding long-term safety and effectiveness. Our observational data indicate that for typical COT patients in community practice the probability of experiencing good pain control and favorable levels of functioning is relatively low. Young and middle-aged women seem to be at particularly high risk for unfavorable global pain status. Given the unique risks that opioid use poses to women in this age group (e.g., reduced fertility and potential effects on the neonate associated with maternal use during pregnancy),34 these unfavorable pain and disability ratings in the presence of patient report of opioid helpfulness make decisions about opioid use in women of reproductive age particularly problematic. In all age groups, the most likely outcomes experienced by patients using opioids long term need to be balanced against known risks of opioid use in both sexes, including opioid misuse, addiction and overdose,35 depression, endocrinopathy, and chronic constipation
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