Characteristics of Pain Treatment for Safety-Net Patients on or Recently on Long-Term Opioid Therapy for Chronic Noncancer Pain, by Level of Satisfaction with Pain Treatment*
| Characteristic, Median (IQR) or n (%) | All Participants (n = 300) | Low Satisfaction (n = 116) | Moderate Satisfaction (n = 85) | High Satisfaction (n = 98) | P Value |
|---|---|---|---|---|---|
| Pain characteristics | |||||
| Pain on average in the past 3 months | 7 (6 to 9) | 8 (7 to 9) | 7 (6 to 8) | 7 (6 to 9) | 0.015 |
| Pain Catastrophizing Scale ≥ 30 | 96 (32%) | 45 (47%) | 27 (28%) | 23 (24%) | 0.06 |
| Cold pressor threshold score | 7.5 (5.1 to 11.5) | 7.7 (5.2 to 11.6) | 7.6 (5.3 to 11.7) | 7.0 (4.3 to 11.0) | 0.61 |
| Cold pressor tolerance score | 10.9 (7.0 to 17.7) | 11.1 (6.9 to 17.7) | 11.5 (7.5 to 17.7) | 10.5 (6.6 to 18.6) | 0.74 |
| Douleur Neuropathique 4 (Neuropathic Pain Assessment) ≥4† | 161 (56%) | 66 (41%) | 48 (30%) | 46 (29%) | 0.23 |
| Prescribed opioid MME at baseline | 60 (17.5 to 180) | 43 (6 to 171) | 60 (23 to 150) | 60 (20 to 222) | 0.22 |
| 0 MME | 50 (17%) | 27 (54%) | 11 (22%) | 12 (24%) | 0.25 |
| 1 to 19 MME | 25 (8%) | 8 (32%) | 6 (24%) | 11 (44%) | |
| 20 to 89 MME | 102 (34%) | 38 (37%) | 33 (32%) | 31 (31%) | |
| 90 to 199 MME | 57 (19%) | 19 (33%) | 20 (35%) | 18 (32%) | |
| ≥200 MME | 66 (22%) | 24 (37%) | 15 (23%) | 26 (40%) | |
| Max MME in past year | 112.5 (36.0 to 246.3) | 105 (40 to 270) | 90 (36 to 216) | 120 (30 to 270) | 0.77 |
| MME decreased >30% and not stopped in past year | 53 (18%) | 24 (45%) | 11 (21%) | 18 (34%) | 0.36 |
| MME increased >30% in past year | 42 (14%) | 13 (31%) | 14 (33%) | 15 (36%) | 0.52 |
| Opioid(s) discontinued in past year | 43 (14%) | 26 (61%) | 9 (21%) | 8 (19%) | 0.006 |
| Self-reported prescribed opioids | |||||
| Oxycodone, hydrocodone | 167 (56%) | 60 (36%) | 46 (28%) | 60 (36%) | 0.36 |
| Hydromorphone | 6 (2%) | 1 (16%) | 0 (0%) | 5 (83%) | 0.03 |
| Morphine | 81 (27%) | 25 (31%) | 28 (35%) | 27 (34%) | 0.19 |
| Methadone | 54 (18%) | 26 (48%) | 16 (30%) | 12 (22%) | 0.15 |
| Fentanyl | 12 (4%) | 3 (25%) | 5 (42%) | 4 (33%) | 0.53 |
| Codeine | 21 (7%) | 6 (29%) | 7 (33%) | 8 (38%) | 0.61 |
| Other opioid | 6 (2%) | 1 (17%) | 4 (68%) | 1 (17%) | 0.11 |
| No opioids | 38 (13%) | 22 (58%) | 6 (16%) | 10 (26%) | 0.03 |
| Self-reported nonopioid medications | |||||
| Acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) | 94 (31%) | 36 (39%) | 29 (31%) | 28 (30%) | 0.72 |
| Gabapentinoids (gabapentin, pregabalin) | 105 (35%) | 38 (37%) | 36 (35%) | 30 (29%) | 0.21 |
| Cannabis (prescribed) | 93 (31%) | 25 (27%) | 30 (33%) | 37 (40%) | 0.02 |
| Muscle relaxants | 43 (14%) | 10 (24%) | 17 (41%) | 15 (36%) | 0.07 |
| Other neuropathic medications‡ | 29 (10%) | 10 (36%) | 7 (25%) | 11 (39%) | 0.74 |
| Topical medications (lidocaine, capsaicin) | 28 (9%) | 14 (50%) | 4 (14%) | 10 (36%) | 0.20 |
| Other medications or do not remember | 12 (4%) | 4 (33%) | 4 (33%) | 4 (33%) | 0.93 |
| No nonopioid medications | 80 (27%) | 36 (45%) | 17 (21%) | 27 (34%) | 0.21 |
| Nonmedication treatments | |||||
| No medications | 10 (3%) | 8 (80%) | 1 (10%) | 1 (10%) | 0.04 |
| Local injections | 55 (18%) | 26 (47%) | 15 (27%) | 14 (26%) | 0.30 |
| Chiropractic care | 24 (8%) | 12 (52%) | 4 (17%) | 7 (30%) | 0.34 |
| Physical or occupational therapy | 86 (29%) | 35 (41%) | 29 (34%) | 22 (26%) | 0.20 |
| Acupuncture | 49 (16%) | 17 (35%) | 12 (25%) | 19 (40%) | 0.55 |
| Massage therapy | 59 (20%) | 20 (35%) | 15 (26%) | 23 (40%) | 0.46 |
| Group or individual behavioral counseling | 53 (18%) | 20 (38%) | 18 (34%) | 15 (28%) | 0.58 |
| Opioid stewardship interventions | |||||
| Pain agreement documented in chart | 208 (69%) | 80 (39%) | 62 (30%) | 66 (32%) | 0.70 |
| Naloxone prescribed in chart | 182 (61%) | 75 (41%) | 52 (29%) | 55 (30%) | 0.44 |
| Urine drug screen done in the past year | 247 (82%) | 100 (40%) | 68 (28%) | 79 (32%) | 0.42 |
IQR, interquartile range; MME, Morphine milligram equivalents.
↵* One participant did not respond to the pain treatment satisfaction question.
↵† There were 14 participants who did not complete neuropathic pain assessment.
↵‡ Other neuropathic medications including tricyclic antidepressants (amitriptyline, desipramine), serotonin-norepinephrine reuptake inhibitors (duloxetine, venlafaxine), migraine medications (sumatriptan, fioricet, midrin, ergotamine, topiramate), and antiseizure medications (valproic acid).