2024/04/12 by Anne Roussin, Zénab Cissé, Vanessa Rousseau +11 · 2 citations
Medicine · #Analgesic #Anxiety #Chronic pain #Concordance #Cross-sectional study #Depression (economics) #Discontinuation #Internal medicine #Medical prescription #Medicine #Musculoskeletal pain and rehabilitation #Opioid #Opioid Use Disorder Treatment #Pain Management and Opioid Use #Pain catastrophizing #Physical therapy #Psychiatry
paper · open access · doi:10.1016/j.therap.2024.01.008
published in Therapies 79(5), 543-551 (Elsevier BV)
openalex publication_date 2024/04/12 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/28
AIM: Patients with chronic non-cancer pain are referred to pain centres to improve their pain treatment. The discontinuation of pain medications in case of poor efficacy can be difficult to accept for patients, particularly opioid analgesics. Previous research has described that from the patients' perspective, the psychological relief of a negative effect of chronic pain and withdrawal symptoms of prescription opioids represent drivers of persistent use and first stage of opioid use disorder, despite insufficient pain relief. There is no validated tool to investigate this psychological dependence. This study aimed to assess discordance between patients and pain specialists in their perception of dependence on pain medication and investigate associations with characteristics of patients, type of pain and iatrogenic pharmacodependence. METHODS: Self-administered questionnaires (patients and physicians) were administered in six pain centres in France. A question on perceived dependence on pain medications was addressed to the patient and the physician in a matched pair. Discordance between them was evaluated by the Cohen kappa coefficient. Demographics, pain, anxiety and depression, pain medication withdrawal symptoms, diverted use, and craving represented variables studied in a multivariate model as potentially associated with patient-physician discordance. RESULTS: According to the 212 pairs of completed questionnaires, a perceived dependence was reported by the majority of patients (65.6%) and physicians (68.4%). However, the concordance was fair (kappa=0.38; CI [95%]: 0.25-0.51). Almost all patients (89.3%) were treated with an opioid analgesic. A higher likelihood of discordance was observed when patients suffered from nociplastic pain (odds ratio [OR]: 2.72, 95% [CI]: 1.29-5.84). CONCLUSION: Medical shared-decision for changing pain treatment could be improved by taking into account the perception of patient dependence on medications for pain relief and or psychoactive effects, particularly in nociplastic pain for which the treatment is challenging.