Social & psychological factors associated with oral analgesic use in knee osteoarthritis management

Abstract

Objective:Determine modifiable social and psychological health factors that are associated with use of oral opioid and non-opioid medications for OA. Methods:Patients were categorized based on use of the following oral medications: opioids (with/without other oral analgesic treatments), non-opioid analgesics, and no oral analgesic treatment. We used multinomial logistic regression models to estimate adjusted relative risk ratios (RRRs) of using an opioid or a non-opioid analgesic (vs. no oral analgesic treatment), comparing patients by levels of social support (Medical Outcomes Study scale), health literacy ("How confident are you filling out medical forms by yourself?"), and depressive symptoms (Patient Health Questionnaire-8). Models were adjusted for demographic and clinical characteristics. Results:In this sample (mean age 64.2 years, 23.6% women), 30.6% (n=110) reported taking opioid analgesics for OA, 54.2% (n=195) reported non-opioid use, and 15.3% (n=55) reported no oral analgesic use. Opioid users had lower mean social support scores (10.0 vs. 10.5 vs. 11.9, p=0.007) and were more likely to have moderate-severe depressive symptoms (42.7% vs. 24.1% vs. 14.5%, p<0.001). Health literacy did not differ by treatment group type. Having moderate-severe depression was associated with higher risk of opioid analgesic use compared to no oral analgesic use (RRR 3.24, 95%CI 1.20, 8.73) when adjusted for sociodemographic and clinical factors. Neither social support nor health literacy was associated with opioid or non-opioid oral analgesic use in fully adjusted models. Conclusions:Knee OA patients with more severe depression symptoms, compared to those without, were more likely to report using opioid analgesics for OA.

The Relationship between Cognitive and Emotional Factors and Healthcare and Medication Use in People Experiencing Pain: A Systematic Review

“…Concerning pain medication use, the literature confirms an at least indirect relationship between the level of general anxiety and/or depressive symptoms and the amount of pain medication used [55,75,100,102,108,118,126,133] and the odds of using opioids [86,94,96,121,122]. Furthermore, the level of catastrophizing was directly related with the odds for using pain medication in general [53,84,89].…”

“…Sum scores on the Downs and Black checklist ranged between 8/16 and 15/16 (mean: 12.3/16) for cross-sectional studies (n = 47) [ 7 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 ], 10/18 and 17/18 (mean: 12.5/18) for observational cohort studies (n = 26) [ 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 ,…”

“…In people experiencing pain, a positive association was found between level of general anxiety symptoms (4 analyses showing a positive association [ 94 , 121 ] and 2 no association [ 122 , 130 ]—67% agreement for a relationship) and depressive symptoms (8 analyses showing a positive association [ 86 , 94 , 96 , 121 , 122 ] and 3 no association [ 61 , 74 , 130 ]—73%) and using opioids based on univariate analyses. However, for depressive symptoms, multivariate analyses indicated the absence of an association with opioid use (2 analyses showing a positive association [ 86 , 101 ] and 4 no association [ 62 , 86 , 101 , 121 ]—33%). Moreover, no evidence was found for a relationship between depressive symptoms and prescription pain medication use (univariate: 2 analyses showing a positive association [ 48 , 76 ] and 16 no association [ 48 , 49 ]—11%), OTC pain medication use (univariate: 1 analyses showing a positive association [ 48 ] and 4 no association [ 48 , 49 ]—20%), having primary care consultation (univariate: 2 analyses showing a positive association [ 112 ] and 5 no association [ 48 , 104 ]—29%), undergoing invasive procedures (univariate: 1 analysis showing a positive association [ 48 ] and 4 no association [ 48 , 131 ]—20%) and using CAM services (univariate: 6 analyses showing a positive association [ 48 , 73 , 115 ] and 23 no association [ 48 , 73 , 77 , 112 ]—21%; multivariate: 5 analyses showing no association [ 73 , ...…”

“…In people experiencing pain, a positive association was found between level of general anxiety symptoms (4 analyses showing a positive association [94,121] and 2 no association [122,130]-67% agreement for a relationship) and depressive symptoms (8 analyses showing a positive association [86,94,96,121,122] and 3 no association [61,74,130]-73%) and using opioids based on univariate analyses. However, for depressive symptoms, multivariate analyses indicated the absence of an association with opioid use (2 analyses showing a positive association [86,101] and 4 no association [62,86,101,121]-33%).…”

“…In people experiencing pain, a positive association was found between level of general anxiety symptoms (4 analyses showing a positive association [94,121] and 2 no association [122,130]-67% agreement for a relationship) and depressive symptoms (8 analyses showing a positive association [86,94,96,121,122] and 3 no association [61,74,130]-73%) and using opioids based on univariate analyses. However, for depressive symptoms, multivariate analyses indicated the absence of an association with opioid use (2 analyses showing a positive association [86,101] and 4 no association [62,86,101,121]-33%). Moreover, no evidence was found for a relationship between depressive symptoms and prescription pain medication use (univariate: 2 analyses showing a positive association [48,76] and 16 no association [48,49] Symptom-related anxiety symptoms were found to be consistently positively related with having primary care consultations in patients with pain (univariate: 3 analyses reporting a positive association [60] and 1 no association [65]-75%).…”