There is considerable debate in the medical community about the role of opioids in the treatment of chronic, nonmalignant pain. The new report suggests that in certain individuals opioids may cause harm in unexpected ways.
"Giving prescription opioids to patients with chronic disabling back pain is fraught with risk," said Mayer, of the PRIDE Productive Rehabilitation Institute in Dallas, Texas.
Those who became opioid dependent one year after completing the program were burdened by substantial psychosocial and medical problems. Typically they had been disabled a year longer than their nonopioid-dependent counterparts (29 vs. 17 months). They were also 2.5 times more likely to have had prior surgery, 2.6 times more likely to have an antisocial or borderline personality disorder, about twice as likely to have had a pre-injury substance use disorder, and 1.7 times more likely to have a major depressive or anxiety disorder.
Even after controlling for these factors, the researchers found that opioid dependence was an independent risk factor for poorer treatment outcomes. Physicians who treat patients with chronic disabling back pain "must be cautious in prescribing chronic opioid medication, and be alert to the de-motivating effect such medication can have," advise Mayer and colleagues.
Despite their disability and functional limitations, "Patients found doctors who were willing to give them the opioids and, more importantly, keep them on opioids," noted Mayer. "Prescription for benign conditions is probably excessive."
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