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Research

Characteristics of patients receiving long-term opioid therapy for chronic noncancer pain: a cross-sectional survey of patients attending the Pain Management Centre at Hamilton General Hospital, Hamilton, Ontario

Jason W. Busse, Hamza Mahmood, Bilal Maqbool, Amna Maqbool, Ali Zahran, Adnan Alwosaibai, Eshaq Alshaqaq, Nav Persaud, Lynn Cooper, Angela Carol, Janice Sumpton, Erin McGinnis, Daniel Rosenbaum, Natalie Lidster and D. Norman Buckley
September 09, 2015 3 (3) E324-E330; DOI: https://doi.org/10.9778/cmajo.20140126
Jason W. Busse
1Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ont.
2Department of Anesthesia, McMaster University, Hamilton, Ont.
3Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont.
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Hamza Mahmood
4Department of Health Sciences, McMaster University, Hamilton, Ont.
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Bilal Maqbool
4Department of Health Sciences, McMaster University, Hamilton, Ont.
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Amna Maqbool
5Department of Biology, McMaster University, Hamilton, Ont.
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Ali Zahran
2Department of Anesthesia, McMaster University, Hamilton, Ont.
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Adnan Alwosaibai
2Department of Anesthesia, McMaster University, Hamilton, Ont.
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Eshaq Alshaqaq
6Anesthesia Department, Saad Specialist Hospital, Saudi Arabia
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Nav Persaud
7Keenan Research Centre in the Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ont.
8Department of Family and Community Medicine, St Michael’s Hospital, Toronto, Ont.
9Department of Family and Community Medicine, University of Toronto, Toronto, Ont.
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Lynn Cooper
10Canadian Pain Coalition, Oshawa, Ont.
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Angela Carol
2Department of Anesthesia, McMaster University, Hamilton, Ont.
11College of Physicians and Surgeons of Ontario, Toronto, Ont.
12Hamilton Urban Core Community Health Centre, Hamilton, Ont.
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Janice Sumpton
13 Pharmacy Department, London Health Sciences Centre, London, Ont.
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Erin McGinnis
14Chronic Disease and Injury Prevention Division, Niagara Region Public Health, Thorold, Ont.
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Daniel Rosenbaum
15Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont.
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Natalie Lidster
15Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont.
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D. Norman Buckley
1Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ont.
2Department of Anesthesia, McMaster University, Hamilton, Ont.
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    Table 1: Participant characteristics (n = 145)*
    CharacteristicNo. (%) of participants†
    Age, yr; mean ± SD52.5 ±13.1
    Gender
    Female90 (62.1)
    Male55 (37.9)
    Educational level
    High school not completed26 (17.9)
    High school graduate41 (28.3)
    College degree55 (37.9)
    University degree23 (15.9)
    Duration of opioid use
    6 mo to 1 yr12 (8.3)
    1−5 yr49 (33.8)
    > 5−10 yr44 (30.3)
    >10 yr40 (27.6)
    Opioid use
    Hydromorphone52 (35.9)
    Oxycodone51 (35.2)
    Codeine17 (11.7)
    Fentanyl16 (11.0)
    Methadone16 (11.0)
    Morphine16 (11.0)
    Tramadol8 (5.5)
    Daily morphine equivalent dose, mg; median (IQR)180 (60−501)
    Presenting clinical condition‡
    Chronic low back pain94 (64.8)
    Chronic neck pain46 (31.7)
    Fibromyalgia30 (20.7)
    Chronic headaches26 (17.9)
    Rheumatoid arthritis21 (14.5%)
    Diabetic neuropathy12 (8.3)
    Chronic whiplash7 (4.8)
    Currently receiving disability (wage replacement) benefits
    Yes99 (68.3)
    No46 (31.7)

    Note: IQR = interquartile range, SD = standard deviation.
*Four patients provided incomplete information for 1 or more of the table items, and we restricted our analyses to those patients (n = 145) who provided complete information.
†Unless otherwise specified.
‡The total is greater than 145 because patients were allowed to endorse more than 1 response option.

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      Table 2: Patient-reported v. confirmed prescriptions for opioids among patients receiving long-term opioid therapy (n = 149)*
      VariableNo. (%)
      CodeineOxycodoneTramadolHydromorphoneMethadoneMorphineOther opioid
      Patients with a confirmed prescription17 (11.4)51 (34.2)8 (5.4)52 (34.9)16 (10.7)16 (10.7)18 (12.1)†
      Patients who did not report a confirmed prescription3 (2.0)0 (0.0)3 (2.0)5 (3.4)1 (0.7)4 (2.7)12 (8.0)†
      Patients who reported a prescription that they did not have6 (4.0)7 (4.7)1 (0.7)10 (6.7)2 (1.3)6 (4.0)26 (17.4)‡

      *Total numbers across rows are greater than 149 because some patients were prescribed more than 1 opioid.
†These were fentanyl patches in all cases.
‡Respondents listed the following drugs as opioids: desipramine, nortriptyline, gabapentin, baclofen, lorazepam, nabilone, pregabalin, naproxen and duloxetine.

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        Table 3: Patient-reported impact of long-term opioid therapy
        ImpactNo. (%)
        of patients
        Degree of pain relief (n = 143)
        < 20%11 (7.7)
        21%−40%26 (18.2)
        41%−60%49 (34.3)
        61%−80%48 (33.6)
        > 81%9 (6.3)
        Degree of functional improvement (n = 142)
        < 20%14 (9.9)
        21%−40%32 (22.5)
        41%−60%50 (35.2)
        61%−80%38 (26.8)
        > 81%8 (5.6)
        Employment status (n = 144)
        Full-time hours, unmodified duties5 (3.5)
        Full-time hours, modified duties5 (3.5)
        Part-time hours, unmodified duties6 (4.2)
        Part-time hours, modified duties8 (5.6)
        Not working103 (71.5)
        Housekeeper/stay-at-home parent3 (2.1)
        Student1 (0.7)
        Retired13 (9.0)
        The adverse effects associated with opioid use are problematic (n = 142)
        Strongly agree28 (19.7)
        Agree38 (26.8)
        Undecided17 (12.0)
        Disagree33 (23.2)
          Strongly disagree26 (18.3)
        • View popup
        Table 4: Patient impressions of the educational pamphlet “Are you thinking about taking opioids (painkillers) for your pain?”
        Patient impressionNo. (%) of patients
        Strongly agreeAgreeUncertainDisagreeStrongly disagree
        I was aware of this information before starting on long-term opioid therapy (n = 143)43 (30.1)64 (44.8)18 (12.6)10 (7.0)8 (5.6)
        This information makes me feel more positively about long-term opioid therapy (n = 143)25 (17.5)61 (42.7)43 (30.1)13 (9.1)1 (0.7)
        If I had this information before I began long-term opioid therapy, I would have decided against long-term opioid therapy (n = 143)1 (0.7)7 (4.9)23 (16.1)66 (46.2)46 (32.2)
        Having read this information now, I am thinking about stopping or decreasing my use of opioids (n = 143)010 (7.0)24 (16.8)53 (37.1)56 (39.2)
        The pamphlet was too complicated/confusing (n = 142)1 (0.7)4 (2.8)16 (11.3)66 (46.5)55 (38.7)
        The pamphlet provided too much information (n = 141)06 (4.3)16 (11.3)72 (51.1)47 (33.3)
        The pamphlet provided too little information (n = 141)3 (2.1)21 (14.9)19 (13.5)65 (46.1)33 (23.4)
        Reading the pamphlet answered all my questions about long-term opioid therapy (n = 141)22 (15.6)55 (39.0)38 (27.0)23 (16.3)4 (2.1)
        Reading the pamphlet reduced my fears about long-term opioid use (n = 141)12 (8.5)51 (36.2)48 (34.0)24 (17.0)6 (4.3)
        Reading the pamphlet increased my fears about long-term opioid use (n = 141)016 (11.3)20 (14.2)73 (51.8)32 (22.7)
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      CMAJ Open: 3 (3)
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      17 Jul 2015
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      Characteristics of patients receiving long-term opioid therapy for chronic noncancer pain: a cross-sectional survey of patients attending the Pain Management Centre at Hamilton General Hospital, Hamilton, Ontario
      Jason W. Busse, Hamza Mahmood, Bilal Maqbool, Amna Maqbool, Ali Zahran, Adnan Alwosaibai, Eshaq Alshaqaq, Nav Persaud, Lynn Cooper, Angela Carol, Janice Sumpton, Erin McGinnis, Daniel Rosenbaum, Natalie Lidster, D. Norman Buckley
      Jul 2015, 3 (3) E324-E330; DOI: 10.9778/cmajo.20140126

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      Characteristics of patients receiving long-term opioid therapy for chronic noncancer pain: a cross-sectional survey of patients attending the Pain Management Centre at Hamilton General Hospital, Hamilton, Ontario
      Jason W. Busse, Hamza Mahmood, Bilal Maqbool, Amna Maqbool, Ali Zahran, Adnan Alwosaibai, Eshaq Alshaqaq, Nav Persaud, Lynn Cooper, Angela Carol, Janice Sumpton, Erin McGinnis, Daniel Rosenbaum, Natalie Lidster, D. Norman Buckley
      Jul 2015, 3 (3) E324-E330; DOI: 10.9778/cmajo.20140126
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