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Abstract
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<h5 class="section-title" id="d4826886e162">Background and Objectives:</h5>
<p id="P1">While research on the separate relationships between health-related quality
of life
(HRQOL) and chronic pain, and HRQOL and opioid abuse has been sparse, even less work
has investigated the factors associated with HRQOL in individuals who have both chronic
pain and meet criteria for opioid use disorder. The data presented in this analysis
should allow a better understanding the factors important to quality of life among
this dual-diagnosed population.
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<h5 class="section-title" id="d4826886e167">Methods:</h5>
<p id="P2">Individuals with dual diagnoses of chronic pain and opioid use disorder
were recruited
for clinical research studies at Columbia University Medical Center. Participants
(
<i>n</i>=47) completed inventories to assess pain (Brief Pain Inventory), opioid (ab)use,
and depression (Beck Depression Inventory). Variable from these and other inventories,
along with demographic factors (age, race, sex, pain severity, depressive symptoms,
duration of opioid use, route of opioid use, amount of opioid use) were entered into
a regression analysis in order to identify the strongest predictors of SF-36 Health
Survey score.
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<h5 class="section-title" id="d4826886e175">Results:</h5>
<p id="P3">In the bivariate analysis we found that demographic and drug use variables
were rarely
associated with HRQOL. Typically, ratings of pain severity and pain interference were
the best predictors. In the multivariate analysis, we found that across the several
HRQOL dimensions greater Brief Pain Inventory (BPI) ratings of pain “interference”
and Beck Depression Inventory (BDI) scores were consistently associated with lower
HRQOL.
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<h5 class="section-title" id="d4826886e180">Conclusions and Scientific Significance:</h5>
<p id="P4">These data suggest that insufficient pain management and depression are
significant
variables contributing to lower quality of life among individuals with chronic pain
and opioid use disorder. (Am J Addict 2017;26:815–821)
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The objectives of this study were to investigate pain cognitions and quality of life of chronic pain patients referred to a multi-disciplinary university pain management clinic and to search for predictors of quality of life. A heterogeneous group of 1208 chronic pain patients referred to the Maastricht university hospital pain clinic participated in this cross-sectional study. At the initial assessment, all patients completed a set of questionnaires on demographic variables, cause, location, pain intensity (McGill pain questionnaire, MPQ), pain coping and beliefs (pain coping and cognition list, PCCL), pain catastrophising (pain catastrophising scale, PCS) and eight dimensions of quality of life (Rand-36). The results showed that the present sample of heterogeneous pain patients reported low quality of life on each domain and significantly lower scores than has been found in previous studies with other Dutch chronic pain populations. Patients with low back pain and multiple pain localisations experienced most functional limitations. Women reported more pain, more catastrophising thoughts about pain, more disability and lower vitality and general health. When tested in a multiple regression analysis, pain catastrophising turned out to be the single most important predictor of quality of life. Especially social functioning, vitality, mental health and general health are significantly associated with pain catastrophising. Patients from a multi-disciplinary university pain clinic experience strikingly low quality of life, whereby low back pain patients and patients with multiple pain localisations have the lowest quality of life. Pain catastrophising showed the strongest association with quality of life, and stronger than pain intensity.
Although its inclusion in medical research is relatively recent and its interpretation is often variable, quality of life is increasingly being recognized as one of the most important parameters to be measured in the evaluation of medical therapies, including those for pain management. Pain, when it is not effectively treated and relieved, has a detrimental effect on all aspects of quality of life. This negative impact has been found to span every age and every type and source of pain in which it has been studied. Effective analgesic therapy has been shown to improve quality of life by relieving pain. Opioid analgesics, cyclooxygenase (COX)-2 inhibitors (or coxibs), and several adjuvant analgesics for neuropathic pain have been demonstrated to significantly improve quality-of-life scores in patients with pain. Coxibs provide effective, well-tolerated analgesia without some of the issues faced with opioids-benefits that should translate into improved quality of life. Recent studies have demonstrated that the COX-2 inhibitor rofecoxib significantly improves quality of life in patients with osteoarthritis and chronic, lower back pain. Quality-of-life measurements, especially symptom distress scales, can also be used as sensitive means of differentiating one agent from another in the same class. In future pharmacotherapeutic research, quality of life should be included as an outcome domain as are the traditionally measured variables of efficacy and safety. In particular, future studies of coxibs should include symptom distress scores as important quality-of-life measurements, to identify meaningful differences between this new class of analgesics and nonselective nonsteroidal anti-inflammatory drugs.
Depression is a major barrier to effective pain relief. The SF-36 Health Survey may be useful as an outcome measure for chronic pain patients with and without depression. The study purpose was to determine the correlation between the SF-36 Mental Composite Scale t-score and depression type in chronic pain patients and the positive predictive value of the SF-36 in classifying depression type in chronic pain patients. Cross-sectional survey of chronic pain patients at baseline assessment. Interdisciplinary pain management center in the North Central United States. Two hundred forty-two consecutive, chronic noncancer pain patients. Assessments of patient-reported health-related quality of life (SF-36), pain, pain type and diagnoses, mental health diagnoses, and patient demographics. SF-36 Health Survey, pain diagnoses, and depression diagnoses. Study participants were 160 women (66%) and 82 men (34%), 95% Caucasian, whose mean age was 46 (+/-0.8 SD) years (range: 19-83). All types and diagnoses of chronic pain were represented. The prevalence of major depressive disorder was 52%. The type of depression was highly correlated with SF-36 score (r=-0.567; P < 0.001). All chronic pain patients had very low SF-36 scores. Compared with U.S. population norms, chronic pain patients with and without depression had significantly lower SF-36 scores as measured by z-scores. Chronic pain patients with major depressive disorder had a significantly lower Mental Composite Score t-score than those with minor or no depression-34.1 and 47.6, respectively (P < 0.001). The positive predictive value of the SF-36 for differentiating major depression from minor or no depression was 98% (sensitivity=84.4%, specificity=93.9%). The SF-36 Mental Composite Score and all subscales were highly correlated with depression type in chronic pain patients. The positive predictive value of the SF-36 in classifying depression type was high. The SF-36 may be a useful clinical tool to measure health-related quality of life in chronic pain patients. In addition, the SF-36 was able to detect major depression and demonstrate a dose-effect relationship between depression type (severity) and health-related quality of life in chronic pain patients.
[1
]Division on Substance Use Disorders, New York State Psychiatric Institute and Department
of Psychiatry; College of Physicians and Surgeons of Columbia University; New York
New York
[2
]Translational Research Training Program in Addiction; City College of New York; New
York
[3
]Sophie Davis School of Biomedical Education; New York New York
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