Quality of Life Associated with Daily Opioid Therapy in a Primary Care Chronic Pain Sample

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Figure 1.
Pain diagnoses among opioid and non-opioid users.
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Figure 2.
Propensity score adjusted difference in SF-36 physical health domain scores versus non-opioid users.
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Figure 3.
Propensity score adjusted difference in SF-36 mental health domain scores versus non-opioid users.

Table 1.

Patient Characteristics Included in Propensity Score Analysis

Demographics^*	No Opioids	Quartile 1	Quartile 2	Quartile 3	Quartile 4	P
Age (median [range])	48 (20–72)	50 (18–79)	48 (20–74)	50 (24–81)	47 (20–68)	.016
Men (%)	30	27	32	35	33	.45
Race (%)
White	74	76	71	75	85	.035
African-American	24	21	28	24	14
Other	2	3	1	1	1
Employment (%)
Full time	32	38	27	32	21	.098
Part time	9	12	16	12	12
Student	1	1	1	1	1
Disability	46	40	42	45	55
Unemployed	12	8	14	11	11
Pain characteristics^†
Average pain (1 = none, 10 = worst imaginable)	6.0	5.9	6.0	6.2	6.2	.57
Worst pain (1 = none, 10 = worst imaginable)	8.8	8.7	8.9	8.8	9.0	.35
Duration of pain (median years)	16.0	14.0	12.5	16.5	18.0	.015
Pain interference (0 = none, 10 = great deal)	7.0	6.9	7.5	7.4	8.0	.011
Psychological comorbidities^‡
P3 anxiety score (mean)	43.0	44.6	44.6	44.2	44.1	.67
P3 depression score (mean)	45.4	45.9	46.3	46.9	47.4	.26
P3 somatization score (mean)	47.4	46.8	48.3	47.8	49.3	.024
Abuse of legal/illegal substance(s)	8.6	6.0	8.0	7.7	5.7	.79

* From the Addiction Severity Index.
† From the Pain Inventory. Score of 21–45 = below average, score of 46–55 = average, and score of 56–71 = above average.
‡ From the Pain Patient Profile (P3) and the Substance Dependence Severity Scale.

Table 2.

Opioid Dosing and Reported Side Effects

	No Opioids	Quartile 1	Quartile 2	Quartile 3	Quartile 4	P
Opioid dose (morphine equivalent/d; median [Q1–Q3 range])	0 (0)	10 (2–19)	25 (30–37)	60 (40–103)	220 (105–1020)	NA
Patients experiencing side effects from opioid use (%)
Headache	9	28	19	23	21	.35
GI upset	11	25	18	24	22	.095
Skin rash/itching	12	27	18	23	20	.84
Depressed appetite	10	23	18	24	25	.094
Sleep disturbance	8	21	13	19	18	.56
Increased depression/anxiety	11	25	18	25	21	.82

Table 3.

SF-36 Subscale Scores of Chronic Pain Patients Compared with US Norms

	Physical Function^*	Role Physical^*	Bodily Pain^*	General Health^*	Mental Health	Role Emotional	Social Function^*	Vitality^*
US norm^†	84.5 (22.9)	81.2 (33.8)	75.5 (23.6)	72.2 (20.2)	74.8 (18.0)	81.3 (33.0)	83.6 (22.4)	61.1 (20.9)
Study sample
No opioids	43.0 (26.9)	25.3 (36.4)	28.7 (15.8)	39.8 (22.1)	60.4 (20.7)	48.0 (42.7)	50.7 (26.6)	37.0 (20.5)
Quartile 1	46.0 (27.8)	26.9 (35.5)	30.7 (16.8)	44.3 (24.5)	61.6 (21.9)	49.1 (43.8)	52.9 (28.8)	36.9 (21.8)
Quartile 2	41.9 (27.4)	24.2 (37.1)	27.3 (17.2)	40.1 (22.3)	59.6 (22.1)	48.3 (42.5)	48.0 (26.2)	37.5 (20.9)
Quartile 3	36.7 (25.0)	18.1 (31.6)	27.0 (16.8)	39.1 (23.0)	61.1 (21.1)	46.1 (42.6)	49.3 (25.6)	37.0 (20.5)
Quartile 4	32.3 (25.2)	16.5 (28.9)	24.4 (15.9)	35.7 (19.7)	60.2 (21.9)	46.3 (44.0)	43.1 (24.2)	32.2 (18.3)

* Kruskal-Wallis test for difference in quality of life score among opioid use groups significant at P = .05.
† difference between U.S. norms and study sample significant at P < .0001 for all domains.
All data shown as mean score (standard deviation).

Table 4.

Opioid Use and Perception of Treatment Efficacy

	No Opioids	Quartile 1	Quartile 2	Quartile 3	Quartile 4	P
Satisfaction^*
With results of treatment to date	3.56	3.51	3.62	3.61	3.84	.044
With ability to do what you want	2.58	2.67	2.62	2.55	2.61	.82
With current treatment of pain	3.54	3.54	3.72	3.78	4.09	.0003
Have control over pain¹	2.78	2.99	2.79	3.00	3.07	.52
Narcotics make a difference in activities^†	7.06	6.88	7.27	7.41	8.01	.0022

* Derived from the Treatment Outcomes in Pain Survey. Satisfaction scores: 1 = completely dissatisfied, 6 = completely satisfied. Pain control score: 0 = none, 6 = complete.
† Derived from pain inventory difference in activities score: 0 = none, 10 = huge.