Patient-Reported Factors Associated with Degree of Pain Medication Dependence and Presence of Severe Dependence Among Spinal Outpatients

Abstract

Aim: To identify risk factors for pain medication dependence. Materials & methods: Chronic spinal pain outpatients (n = 106) completed the Leeds Dependence Questionnaire (LDQ) and measures of potential risk factors. Participants with high (n = 3) and low (n = 3) dependence were interviewed. Results: Mean LDQ score was 11.52 (standard deviation 7.35) and 15/106 participants (14.2%) were severely dependent (LDQ ≥20). In linear regression, pain intensity (β = 0.313, p < 0.001), being disabled by pain (β = 0.355, p < 0.001), borrowing pain medication (β = 0.209, p = 0.006), and emergency phone calls or clinic visits (β = 0.169, p = 0.029) were associated with degree of dependence across the range of LDQ scores. In logistic regression, pain intensity (p = 0.001) and borrowing pain medication (p = 0.004) increased the odds of severe dependence. Interviewees described how their pain influenced their pain medication use and one described pain medication addiction. Conclusion: Interventions to reduce pain intensity and pain-related disability may reduce pain medication dependence.

Lay abstract

This study examined painkiller dependence among 106 people with chronic spinal pain. Participants had mild to moderate dependence on average, but 14% (15/106) had severe dependence. Statistical analysis showed that having more intense pain, being disabled by pain, needing to borrow painkillers, and needing to make emergency phone calls or clinic visits because of pain were all related to increased dependence, and more intense pain and borrowing painkillers made severe dependence more likely. Six participants who were interviewed described how their pain influenced their painkiller use and they also described their concerns about using painkillers, including becoming addicted to painkillers. These findings can guide ways to help people with chronic spinal pain to reduce or avoid painkiller dependence.

Tweetable abstract

Evidence about risk factors for painkiller dependence among people receiving hospital treatment for chronic spinal pain.

Keywords::

• addiction
• chronic pain
• dependence
• painkiller
• pain medication
• spinal pain

Supplementary data

To view the supplementary data that accompany this paper please visit the journal website at: www.tandfonline.com/doi/suppl/10.2217/pmt-2021-0055

Acknowledgments

The authors would like to thank all the participants in the study, and all the staff at the Spinal Outpatients Department, Royal Derby Hospital, and the Physiotherapy Department, London Road Community Hospital, Derby, for helping facilitate data collection, especially L Vale, S Falconbridge, D Wetherall and B Wilsdon. The authors also wish to thank E Borrie for helping with pain medication coding, M Cope for helping with conducting and transcribing interviews, and D Clarke for helpful comments on an earlier draft of the manuscript. The authors also wish to thank the anonymous reviewers for their helpful comments on a previous draft.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. In addition, for investigations involving human subjects, informed consent has been obtained from the participants involved.