Patient and physician perceptions of treatment of moderate-to-severe chronic pain with oral opioids

Abstract

Objective:

To study physician and patient perceptions of moderate-to-severe chronic pain and its management with oral opioids.

Methods:

Two separate surveys were developed and administered to one of two respective study groups: patients and physicians. All study participants recruited from a pool of individuals who had previously agreed to participate in market research. Survey questions addressed the impact of various factors (e.g., quality of life indicators, potential for opioid addiction, side-effects) on pain management decision making, patient satisfaction and compliance. Responses for the first 500 patients and 275 physicians to respond were assessed using descriptive statistics.

Results:

On average, patients were 53 years of age, white (89%), and female (71%). The majority of patients (80%) had been taking oral opioids longer than 6 months. Physicians reported that 45% of their patients received schedule II opioids, with 27% having severe chronic pain. Patients indicated the most common activities interfered with by chronic pain were exercising (76% of patients), working outside the home (67%), and job responsibilities (60%). When developing a treatment approach physicians considered patients’ sleeping (91%), walking (86%), maintaining an independent lifestyle (84%), and job responsibilities (83%). Patients and physicians both rated the ability to relieve pain and the duration of relief as the most important factors when considering opioid therapy. The majority (63%) of patients reported experiencing opioid side effects. When physicians discontinued opioids due to side effects, the most frequent reason was nausea (78%) for immediate-release opioids, and constipation (64%) for extended-release formulations.

Conclusion:

The ability to relieve pain and the duration of that pain relief are the most important factors for both patients and physicians when selecting an opioid. A high percentage of patients surveyed experienced side effects related to their treatment, which may impact adherence and overall treatment effectiveness. Study results should be assessed within study limitations including responder and selection biases, physicians responded about their patients, who were not the same patients surveyed, and the fact that the survey instruments were not formally validated. Further research is warranted to address these limitations.

Key words::

• Adverse effects
• Attitude to health
• Opioids
• Pain

Transparency

Declaration of funding

Study funding was provided by Ortho-McNeil Janssen Scientific Affairs, Titusville, NJ.

Declaration of financial/other relationships

L.S. and A.O. have disclosed that they are employed by Analytica International and received funding from Ortho-McNeil Janssen for the research. L.D. is employed by the Academy of Pain Management and received funding from Ortho-McNeil Janssen for the research. N.E. is employed by the American Society for Pain Management Nursing and received funding from Ortho- McNeil Janssen for the research. A.M. is employed by Stanford University and received funding from Ortho-McNeil Janssen for the research. M.B. is employed by the American Pain Foundation and received funding from Ortho- McNeil Janssen for the research.

Peer reviewers may receive honoraria from CMRO for their review work. Peer Reviewer 1 has disclosed that he/she is the recipient of research/grant funding from Alcon, Abbott, Ortho-McNeil Janssen, Novartis, Sanofi-Aventis, NPS Pharmaceuticals, Boehringer-Ingelheim and TAP Pharmaceuticals, and is a consultant/advisor to, and member of the speakers bureau of Sanofi-Aventis. Peer Reviewer 2 has disclosed that he/she is the recipient of research/grant funding from Amgen.

Acknowledgements

Editorial assistance was provided by Jonathan M. Chulikavit and Jacob M. Willet, both of whom are employed by Analytica International and received funding form Ortho-McNeil Janssen for their contributions to the manuscript preparation.

These data have been presented in part at the 2009 National Conference on Health Communication, Marketing, and Media in Atlanta, GA, August 11–13, 2009.