Opioid use for non-malignant pain moderates patient satisfaction...

[drusso]

This is a good population-based study to share with your JCAHO Prep and Press-Ganey review committees...I wonder why patients with chronic pain who use opioids are satisfied even if they are consuming more services??


Consumption of and satisfaction with health care among opioid users with chronic non-malignant pain.
Hansen AB1, Skurtveit S2,3, Borchgrevink PC1,4, Dale O1,5, Romundstad PR6, Mahic M2, Fredheim OM1,4,7.

Abstract
BACKGROUND:
Although persons with chronic pain are frequent users of the health care system, they report poor satisfaction with health care services. Participants with persistent opioid use in Nord-Trøndelag Health Study (HUNT)3 report severe pain in spite of treatment. The aim of the study was to test the hypothesis that subjects with persistent opioid use have both a higher consumption of health care services and a poorer satisfaction than the remaining subjects reporting chronic pain.

METHODS:
This cross-sectional study was based on linkage of self-reported data from the substudy (10,238 were invited, 6927 met the inclusion criteria) of health care use in HUNT3; a population-based health survey during the years 2006-2008 and the complete national registers of the Norwegian Prescription Database and the Cancer Registry of Norway. Patients with chronic pain are stratified according to the level of opioid use as persistent users of opioids, intermittent users, and persons not using opioids.

RESULTS:
Persons with chronic non-malignant pain reported a higher consumption of all health care services compared to the control group. Consumption of health care services increased with increasing level of opioid use. Persons with persistent opioid use were highly satisfied with all health care services, although less satisfied than persons without chronic pain.

CONCLUSIONS:
Combined with previous findings of high levels of pain in spite of opioid treatment, the present findings indicate that symptomatic relief is not a prerequisite for patient satisfaction. The study shows higher patient satisfaction compared to previous studies.

© 2015 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

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[emd123]

Lol. Of course

 

[Ducttape]

Cross sectional study. I wonder if the increased patient satisfaction actually comes from the increased use of resources rather than the treatment with or dose of opioids.

 

[101N]

"Persons with chronic non-malignant pain reported a higher consumption of all health care services compared to the control group."

This important fact harkens back to our discussions on the private forum.

 

[drusso]

Cross sectional study. I wonder if the increased patient satisfaction actually comes from the increased use of resources rather than the treatment with or dose of opioids.

Health systems have to cover fixed over-head costs in order to justify higher capitated reimbursement. Need to "feed the machine." Health systems can't afford to have idle resources...they need to find the "sweet spot,"---that optimal churn to justify higher reimbursement and make the depreciation schedules pencil out, but not go negative. It's a win-win-win: Patients like to consume resources, doctors like to use resources, central planners need to justify the availability of resources...the opioids simply lubricates the system.

The solution is very simple. Pay people to do as little as possible. The government has been doing with farm subsidies for years...

 

[drusso]

"Persons with chronic non-malignant pain reported a higher consumption of all health care services compared to the control group."

This important fact harkens back to our discussions on the private forum.

...and higher satisfaction...

 

[101N]

This is a study out of Norway, which has universal health care not FFS.

Nevertheless, if their population incidence of 'central sensitization' is as high
as ours you can bet that that accounts for a large measure of the consumption.

This 'perspective' on disease is a very, very expensive one...

"here were several studies suggesting significant benefits from cognitive-behavioral therapy. "The distress I have is from my illness, not from social forces," she replied. Her voice cracked, and she paused for a moment to compose herself. "It's like being in prison in your body." She would never see someone like Dr. Barsky, she explained. "I won't see any doctor who questions the legitimacy of what I have."

 

[drusso]

This is a study out of Norway, which has universal health care not FFS.

Nevertheless, if their population incidence of 'central sensitization' is as high
as ours you can bet that that accounts for a large measure of the consumption.

This 'perspective' on disease is a very, very expensive one...

"here were several studies suggesting significant benefits from cognitive-behavioral therapy. "The distress I have is from my illness, not from social forces," she replied. Her voice cracked, and she paused for a moment to compose herself. "It's like being in prison in your body." She would never see someone like Dr. Barsky, she explained. "I won't see any doctor who questions the legitimacy of what I have."

The Scandinavian pain studies in general don't generalize well to the USA because of the very different cultural attitudes toward pain, health care systems, etc. This is no different. I always view them as "best case" scenarios for what a particular intervention might look like. USA is much more culturally diverse and American patients--regardless of degree of assimilation, have different expectations. Still, this is an example of how I think misapplying population-based studies can be misleading for our field.

Here is how it works : research changes policy, policy changes payment, payment changes practice.

 

[101N]

Pain Med. 2015 May 22. doi: 10.1111/pme.12773. [Epub ahead of print]
Pharmaceutical Opioid Use and Dependence among People Living with Chronic Pain: Associations Observed within the Pain and Opioids in Treatment (POINT) Cohort.
Campbell G1, Nielsen S1, Larance B1, Bruno R2, Mattick R1, Hall W3,4, Lintzeris N5,6, Cohen M7, Smith K1, Degenhardt L1,8,9,10.
Author information

Abstract
OBJECTIVE:
There is increasing concern about the appropriateness of prescribing pharmaceutical opioids for chronic non-cancer pain (CNCP), given the risks of problematic use and dependence. This article examines pharmaceutical opioid dose and dependence and examines the correlates of each.

DESIGN:
Baseline data were obtained from a national sample of 1,424 people across Australia (median 58 years, 55% female and experiencing pain for a median of 10 years), who had been prescribed opioids for CNCP. Current opioid consumption was estimated in oral morphine equivalent (OME; mg per day), and ICD-10 pharmaceutical opioid dependence was assessed using the Composite International Diagnostic Interview.

RESULTS:
Current opioid consumption varied widely: 8.8% were taking <20 mg OME per day, 52.1% were taking 21-90 mg OME, 24.3% were taking 91-199 mg OME, and 14.8% were taking >= 200 mg OME. Greater daily OME consumption was associated with higher odds of multiple physical and mental health issues, aberrant opioid use, problems associated with opioid medication and opioid dependence. A significant minority, 8.5%, met criteria for lifetime ICD-10 pharmaceutical opioid dependence and 4.7% met criteria for past year ICD-10 pharmaceutical opioid dependence. Multivariate analysis found past-year dependence was independently associated with being younger, exhibiting more aberrant behaviors and having a history of benzodiazepine dependence.

CONCLUSIONS:
In this population of people taking opioids for CNCP, consumption of higher doses was associated with increased risk of problematic behaviors, and was more likely among people with a complex profile of physical and mental health problems.

 

[Mad Jack]

I lol'd.

 

[drusso]

Pain Med. 2015 May 22. doi: 10.1111/pme.12773. [Epub ahead of print]
Pharmaceutical Opioid Use and Dependence among People Living with Chronic Pain: Associations Observed within the Pain and Opioids in Treatment (POINT) Cohort.
Campbell G1, Nielsen S1, Larance B1, Bruno R2, Mattick R1, Hall W3,4, Lintzeris N5,6, Cohen M7, Smith K1, Degenhardt L1,8,9,10.
Author information

Abstract
OBJECTIVE:
There is increasing concern about the appropriateness of prescribing pharmaceutical opioids for chronic non-cancer pain (CNCP), given the risks of problematic use and dependence. This article examines pharmaceutical opioid dose and dependence and examines the correlates of each.

DESIGN:
Baseline data were obtained from a national sample of 1,424 people across Australia (median 58 years, 55% female and experiencing pain for a median of 10 years), who had been prescribed opioids for CNCP. Current opioid consumption was estimated in oral morphine equivalent (OME; mg per day), and ICD-10 pharmaceutical opioid dependence was assessed using the Composite International Diagnostic Interview.

RESULTS:
Current opioid consumption varied widely: 8.8% were taking <20 mg OME per day, 52.1% were taking 21-90 mg OME, 24.3% were taking 91-199 mg OME, and 14.8% were taking >= 200 mg OME. Greater daily OME consumption was associated with higher odds of multiple physical and mental health issues, aberrant opioid use, problems associated with opioid medication and opioid dependence. A significant minority, 8.5%, met criteria for lifetime ICD-10 pharmaceutical opioid dependence and 4.7% met criteria for past year ICD-10 pharmaceutical opioid dependence. Multivariate analysis found past-year dependence was independently associated with being younger, exhibiting more aberrant behaviors and having a history of benzodiazepine dependence.

CONCLUSIONS:
In this population of people taking opioids for CNCP, consumption of higher doses was associated with increased risk of problematic behaviors, and was more likely among people with a complex profile of physical and mental health problems.

I wonder how satisfied they were with their treatment...