Opioids: How to Improve Compliance and Adherence

Abstract

Chronic pain has been recognized as a major worldwide health care problem. Today, medical experts and health agencies agree that chronic pain should be treated with the same priority as the disease that caused it, and patients should receive adequate pain relief. To achieve good analgesia, patient adherence to a prescribed pain treatment is of high importance. Patients with chronic pain often do not use their medication as prescribed, but change the frequency of intake. This can result in poor treatment outcomes and may necessitate additional emergency treatment, which increases the overall costs. Factors that influence adherence include knowledge of the disease, realistic treatment expectations, perceived benefit from treatment, side effects, depression, dosing frequency, and attitudes of relatives/significant others toward opioids. Addressing all these factors should ensure a good treatment outcome. Good adherence to pain therapy is associated with improved efficacy in pain relief and quality of life. Opioids have become an integral part of the treatment of moderate to severe chronic noncancer pain. They may cause unpleasant side effects such as nausea, vomiting, and constipation. Patients should be informed adequately about side effects, which should be treated pro-actively to foster adherence to treatment. Signs of tolerance, hyperalgesia, and drug abuse should be monitored as these may occur in some patients. An individualized treatment algorithm with a clear treatment goal and regular treatment reassessment is key for successful treatment. Long-acting opioids offer sustained pain relief over 24 hours with manageable side effects-they simplify treatment thereby supporting treatment adherence.

Chronic non‐cancer pain and the epidemic prescription of opioids in the Danish population: trends from 2000 to 2013

“…As the present study only analyzed register‐based data on dispensed medicine, it is not possible to assess compliance and adherence. A previous study showed that patients with chronic pain often do not use their medication as prescribed . Furthermore, the results presented in Table (dispensed opioids in 2000–2013 by gender and age among individuals with CNCP) should be interpreted with some caution due to the limited number of subjects within each subgroup.…”

Interpretation of Urine Drug Testing in Pain Patients

“…In fact, patients with chronic pain commonly modify their prescribed medication regimens [21,22]. Due to the variable nature of pain, patients may adjust their regimen based on the frequency or intensity of pain [23–47]. Published evidence has shown that adherence to opioid analgesics may be medication dependent, as demonstrated in Table 1.…”

Determinants of Adherence to Delayed-Release Doxylamine and Pyridoxine in Patients With Nausea and Vomiting of Pregnancy

“…This perceived treatment efficacy has been previously reported to be a predictor of medication adherence in multiple settings and disorders. 21–23 This association between the change in PUQE score and adherence was found despite the fact that there was no difference in the adherence rates between subjects in the Diclectin® or placebo arms of the study. This may be related to the complex multifactorial etiology of adherence to medications.…”