Opioid use as a predictor of health care use and pain outcomes: Analysis of clinical trial data

Erin E. Krebs, Kurt Kroenke, Jingwei Wu, Matthew Bair, Mary Ann Kozak, Zhangsheng Yu

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective. To examine effects of pre-enrollment opioid use on outcomes of a 12-month collaborative pain care management trial. We hypothesized that participants with opioid use would have worse pain at baseline; use more health care services and analgesics; and have worse pain outcomes during the trial. Design. Secondary analysis of randomized con- trolled trial data. Setting. Veterans Affairs (VA) primary care. Subjects. Patients age 18-65 years with chronic pain of at least moderate severity who were enrolled in a 12-month pragmatic trial of a telephone-based collaborative care intervention for chronic musculoskeletal pain. Methods. Participants were categorized as opioid users (n = 84) or non-users (n = 166) at baseline and trial randomization was stratified by opioid use. We used logistic regression to examine cross-sectional associations with baseline opioid use and mixed-effect models for repeated measures to examine baseline opioid use as a predictor of Brief Pain Inventory (BPI) scores over 12 months. Results. At baseline, 33.6% reported use of prescribed opioids. Baseline opioid users had higher baseline BPI scores and higher health-related disability than non-users. Baseline opioid users also had more outpatient visits (15.0 vs. 10.1; p = 0.001) and received more analgesics (p < 0.001) during the trial. In the final multivariable model examining effects of baseline opioid use on BPI over 12 months, opioid users and nonusers had a non-significant difference of 0.25 points (p = 0.098). In conclusion, although baseline opioid users had worse pain at baseline and used more health care during the study, response to the intervention was not significantly modified by pre-existing opioid therapy.

Original languageEnglish (US)
Pages (from-to)1261-1268
Number of pages8
JournalPain Medicine (United States)
Volume17
Issue number7
DOIs
StatePublished - Jul 1 2016

Fingerprint

Opioid Analgesics
Clinical Trials
Delivery of Health Care
Pain
Chronic Pain
Equipment and Supplies
Analgesics
Pragmatic Clinical Trials
Musculoskeletal Pain
Veterans
Pain Management
Random Allocation
Telephone
Health Services
Primary Health Care
Outpatients
Randomized Controlled Trials
Logistic Models

Keywords

  • Chronic pain
  • Opioid analgesics
  • Primary care

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Opioid use as a predictor of health care use and pain outcomes : Analysis of clinical trial data. / Krebs, Erin E.; Kroenke, Kurt; Wu, Jingwei; Bair, Matthew; Kozak, Mary Ann; Yu, Zhangsheng.

In: Pain Medicine (United States), Vol. 17, No. 7, 01.07.2016, p. 1261-1268.

Research output: Contribution to journalArticle

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N2 - Objective. To examine effects of pre-enrollment opioid use on outcomes of a 12-month collaborative pain care management trial. We hypothesized that participants with opioid use would have worse pain at baseline; use more health care services and analgesics; and have worse pain outcomes during the trial. Design. Secondary analysis of randomized con- trolled trial data. Setting. Veterans Affairs (VA) primary care. Subjects. Patients age 18-65 years with chronic pain of at least moderate severity who were enrolled in a 12-month pragmatic trial of a telephone-based collaborative care intervention for chronic musculoskeletal pain. Methods. Participants were categorized as opioid users (n = 84) or non-users (n = 166) at baseline and trial randomization was stratified by opioid use. We used logistic regression to examine cross-sectional associations with baseline opioid use and mixed-effect models for repeated measures to examine baseline opioid use as a predictor of Brief Pain Inventory (BPI) scores over 12 months. Results. At baseline, 33.6% reported use of prescribed opioids. Baseline opioid users had higher baseline BPI scores and higher health-related disability than non-users. Baseline opioid users also had more outpatient visits (15.0 vs. 10.1; p = 0.001) and received more analgesics (p < 0.001) during the trial. In the final multivariable model examining effects of baseline opioid use on BPI over 12 months, opioid users and nonusers had a non-significant difference of 0.25 points (p = 0.098). In conclusion, although baseline opioid users had worse pain at baseline and used more health care during the study, response to the intervention was not significantly modified by pre-existing opioid therapy.

AB - Objective. To examine effects of pre-enrollment opioid use on outcomes of a 12-month collaborative pain care management trial. We hypothesized that participants with opioid use would have worse pain at baseline; use more health care services and analgesics; and have worse pain outcomes during the trial. Design. Secondary analysis of randomized con- trolled trial data. Setting. Veterans Affairs (VA) primary care. Subjects. Patients age 18-65 years with chronic pain of at least moderate severity who were enrolled in a 12-month pragmatic trial of a telephone-based collaborative care intervention for chronic musculoskeletal pain. Methods. Participants were categorized as opioid users (n = 84) or non-users (n = 166) at baseline and trial randomization was stratified by opioid use. We used logistic regression to examine cross-sectional associations with baseline opioid use and mixed-effect models for repeated measures to examine baseline opioid use as a predictor of Brief Pain Inventory (BPI) scores over 12 months. Results. At baseline, 33.6% reported use of prescribed opioids. Baseline opioid users had higher baseline BPI scores and higher health-related disability than non-users. Baseline opioid users also had more outpatient visits (15.0 vs. 10.1; p = 0.001) and received more analgesics (p < 0.001) during the trial. In the final multivariable model examining effects of baseline opioid use on BPI over 12 months, opioid users and nonusers had a non-significant difference of 0.25 points (p = 0.098). In conclusion, although baseline opioid users had worse pain at baseline and used more health care during the study, response to the intervention was not significantly modified by pre-existing opioid therapy.

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