Screening for Current Opioid Misuse and Associated Risk Factors among Patients with Chronic Nonalcoholic Pancreatitis Pain

Abstract

Objective The objective of this study is to assess clinical variables that may be associated with risk for opioid misuse in individuals with chronic pancreatitis. Design This study utilized a descriptive, quasi-experimental, cross sectional design. Setting and Patients Three hundred seven individuals with nonalcoholic chronic pancreatitis engaged in chronic opioid therapy for pain presented to an outpatient specialty clinic at an academic medical center. Measures Participants completed the Current Opioid Misuse Measure (COMM), Brief Pain Inventory (BPI), Short Form (SF)-12 Quality of Life Measure, Center for Epidemiological Studies 10-item Depression Scale (CESD), and a single item asking about current alcohol use. Mean scores on the CESD, COMM, BPI, SF-12, and factors associated with opioid misuse measures from regression analyses were the outcome measures. Results Mean scores on the CESD, COMM, BPI pain-on-average item, and the SF-12 physical and psychological quality of life factors (t scores) were 11.2 (standard deviation [SD] = 6.7), 8.5 (SD = 7.3), 4.8 (SD = 2.8), 39.7 (SD = 7.0), and 45 (SD = 9.0), respectively. Descriptive analyses revealed that 55% of participants scored above the clinical cutoff for depression on the CESD, and 39% scored above the cutoff for opioid misuse concerns on the COMM. Regression analyses identified several factors associated with higher opioid misuse measure scores, including increased depressive symptoms from the CESD (β = 0.38, P < 0.0001), increased pain rating at the time of the office visit (β = 0.16, P = 0.03), impairment of psychological quality of life (β = −0.27, P = 0.001) and endorsement of alcohol use (β = 0.16, P = 0.03). These factors accounted for 37% of the variance in current opioid misuse scores. Conclusions Depression, quality of life, pain intensity and alcohol use may be good candidate variables for prospective studies to determine clinical risk factors for opioid misuse among patients with pancreatitis.

Prevalence and determinants of medication non‐adherence in chronic pain patients: a systematic review

“…The Pubmed and Embase search retrieved 2803 and 3990 citations, respectively. Eighty full‐text articles were retrieved, 25 articles were included in this review. Excluded articles are listed in Supporting Information Appendix 1.…”

Strategies to Identify and Reduce Opioid Misuse Among Patients with Gastrointestinal Disorders: A Systematic Scoping Review

“…Outside of the use of PDMP data, Barth et al and Minkowitz et al described the use of screening tools administered to identify opioid misuse and opioid-related adverse events [65–66]. This strategy aligned with clinical information systems as the authors collected and incorporated patient- and population-level data to facilitate efforts to reduce opioid use.…”

“…This strategy aligned with clinical information systems as the authors collected and incorporated patient- and population-level data to facilitate efforts to reduce opioid use. In their descriptive, cross-sectional study, Barth et al used the validated, 17-item Current Opioid Misuse Measure (COMM) survey scale and collected data on quality of life, pain and depression among a sample of 307 patients with chronic pancreatitis at a single center [65]. The COMM was designed by clinical experts in addiction and pain medicine to understand how patients use their opioid medications.…”

“…Second, a growing proportion of patients with GI disorders are considered at risk for adverse events associated with opioid misuse and abuse [29, 32–33]. Factors linked with the greatest risk of opioid misuse in GI care include concurrent pain diagnoses or psychiatric illnesses, frequent health care use, and lower quality of life [34–37]. Third, longer durations of opioid use can paradoxically worsen abdominal pain symptoms and may lead to opioid bowel dysfunction and narcotic bowel syndrome [38].…”

Chronic pancreatitis

“…Medical treatment options for painful chronic pancreatitis include avoidance of alcohol and smoking, pancreatic enzymes, pain medications, antioxidants, and adjunctive agents [10]. Addiction and the abuse of narcotics do occur in these patients, and are particularly significant in patients with depression, higher pain intensity, and alcohol use [35]. Addiction and the abuse of narcotics do occur in these patients, and are particularly significant in patients with depression, higher pain intensity, and alcohol use [35].…”