Correlates of Use and Perceived Effectiveness of Non-pharmacologic Strategies for Chronic Pain Among Patients Prescribed Long-term Opioid Therapy

Crystal C. Lozier, Shannon M. Nugent, Ning X. Smith, Bobbi Jo Yarborough, Steven Dobscha, Richard (Rick) Deyo, Benjamin Morasco

Research output: Contribution to journalArticle

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Abstract

Objective: Non-pharmacologic treatments (NPTs) are recommended for chronic pain. Information is limited on patient use or perceptions of NPTs. We examined the frequency and correlates of use and self-rated helpfulness of NPTs for chronic pain among patients who are prescribed long-term opioid therapy (LTOT). Methods: Participants (n = 517) with musculoskeletal pain who were prescribed LTOT were recruited from two integrated health systems. They rated the frequency and utility of six clinician-directed and five self-directed NPTs for chronic pain. We categorized NPT use at four levels based on number of interventions used and frequency of use (none, low, moderate, high). Analyses examined clinical and demographic factors that differed among groups for both clinician-directed and self-directed NPTs. Results: Seventy-one percent of participants reported use of any NPT for pain within the prior 6 months. NPTs were rated as being helpful by more than 50% of users for all treatments assessed (range 51–79%). High users of clinician-directed NPTs were younger than non-users or low-frequency users and had the most depressive symptoms. In both clinician-directed and self-directed categories, high NPT users had significantly higher pain disability compared to non-NPT users. No significant group differences were detected on other demographic or clinical variables. In multivariable analyses, clinician-directed NPT use was modestly associated with younger age (OR = 0.97, 95% CI = 0.96–0.98) and higher pain disability (OR = 1.01, 95% CI = 1.00–1.02). Variables associated with greater self-directed NPT use were some college education (OR = 1.80, 95% CI = 1.13–2.84), college graduate or more (OR = 2.02, 95% CI = 1.20–3.40), and higher pain disability (OR = 1.01, 95% CI = 1.01–1.02). Conclusions: NPT use was associated with higher pain disability and younger age for both clinician-directed and self-directed NPTs and higher education for self-directed NPTs. These strategies were rated as helpful by those that used them. These results can inform intervention implementation and be used to increase engagement in NPTs for chronic pain.

Original languageEnglish (US)
Pages (from-to)46-53
Number of pages8
JournalJournal of General Internal Medicine
Volume33
DOIs
StatePublished - May 1 2018

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Chronic Pain
Opioid Analgesics
Therapeutics
Pain
Demography
Education
Musculoskeletal Pain

Keywords

  • chronic pain
  • long-term opioid therapy
  • non-pharmacologic pain management

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Correlates of Use and Perceived Effectiveness of Non-pharmacologic Strategies for Chronic Pain Among Patients Prescribed Long-term Opioid Therapy. / Lozier, Crystal C.; Nugent, Shannon M.; Smith, Ning X.; Yarborough, Bobbi Jo; Dobscha, Steven; Deyo, Richard (Rick); Morasco, Benjamin.

In: Journal of General Internal Medicine, Vol. 33, 01.05.2018, p. 46-53.

Research output: Contribution to journalArticle

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abstract = "Objective: Non-pharmacologic treatments (NPTs) are recommended for chronic pain. Information is limited on patient use or perceptions of NPTs. We examined the frequency and correlates of use and self-rated helpfulness of NPTs for chronic pain among patients who are prescribed long-term opioid therapy (LTOT). Methods: Participants (n = 517) with musculoskeletal pain who were prescribed LTOT were recruited from two integrated health systems. They rated the frequency and utility of six clinician-directed and five self-directed NPTs for chronic pain. We categorized NPT use at four levels based on number of interventions used and frequency of use (none, low, moderate, high). Analyses examined clinical and demographic factors that differed among groups for both clinician-directed and self-directed NPTs. Results: Seventy-one percent of participants reported use of any NPT for pain within the prior 6 months. NPTs were rated as being helpful by more than 50{\%} of users for all treatments assessed (range 51–79{\%}). High users of clinician-directed NPTs were younger than non-users or low-frequency users and had the most depressive symptoms. In both clinician-directed and self-directed categories, high NPT users had significantly higher pain disability compared to non-NPT users. No significant group differences were detected on other demographic or clinical variables. In multivariable analyses, clinician-directed NPT use was modestly associated with younger age (OR = 0.97, 95{\%} CI = 0.96–0.98) and higher pain disability (OR = 1.01, 95{\%} CI = 1.00–1.02). Variables associated with greater self-directed NPT use were some college education (OR = 1.80, 95{\%} CI = 1.13–2.84), college graduate or more (OR = 2.02, 95{\%} CI = 1.20–3.40), and higher pain disability (OR = 1.01, 95{\%} CI = 1.01–1.02). Conclusions: NPT use was associated with higher pain disability and younger age for both clinician-directed and self-directed NPTs and higher education for self-directed NPTs. These strategies were rated as helpful by those that used them. These results can inform intervention implementation and be used to increase engagement in NPTs for chronic pain.",
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T1 - Correlates of Use and Perceived Effectiveness of Non-pharmacologic Strategies for Chronic Pain Among Patients Prescribed Long-term Opioid Therapy

AU - Lozier, Crystal C.

AU - Nugent, Shannon M.

AU - Smith, Ning X.

AU - Yarborough, Bobbi Jo

AU - Dobscha, Steven

AU - Deyo, Richard (Rick)

AU - Morasco, Benjamin

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N2 - Objective: Non-pharmacologic treatments (NPTs) are recommended for chronic pain. Information is limited on patient use or perceptions of NPTs. We examined the frequency and correlates of use and self-rated helpfulness of NPTs for chronic pain among patients who are prescribed long-term opioid therapy (LTOT). Methods: Participants (n = 517) with musculoskeletal pain who were prescribed LTOT were recruited from two integrated health systems. They rated the frequency and utility of six clinician-directed and five self-directed NPTs for chronic pain. We categorized NPT use at four levels based on number of interventions used and frequency of use (none, low, moderate, high). Analyses examined clinical and demographic factors that differed among groups for both clinician-directed and self-directed NPTs. Results: Seventy-one percent of participants reported use of any NPT for pain within the prior 6 months. NPTs were rated as being helpful by more than 50% of users for all treatments assessed (range 51–79%). High users of clinician-directed NPTs were younger than non-users or low-frequency users and had the most depressive symptoms. In both clinician-directed and self-directed categories, high NPT users had significantly higher pain disability compared to non-NPT users. No significant group differences were detected on other demographic or clinical variables. In multivariable analyses, clinician-directed NPT use was modestly associated with younger age (OR = 0.97, 95% CI = 0.96–0.98) and higher pain disability (OR = 1.01, 95% CI = 1.00–1.02). Variables associated with greater self-directed NPT use were some college education (OR = 1.80, 95% CI = 1.13–2.84), college graduate or more (OR = 2.02, 95% CI = 1.20–3.40), and higher pain disability (OR = 1.01, 95% CI = 1.01–1.02). Conclusions: NPT use was associated with higher pain disability and younger age for both clinician-directed and self-directed NPTs and higher education for self-directed NPTs. These strategies were rated as helpful by those that used them. These results can inform intervention implementation and be used to increase engagement in NPTs for chronic pain.

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