Aust Health Rev. 2015 Nov 25. doi: 10.1071/AH15047. [Epub ahead of print]
Abstract
Objective The aims of the present study were to describe the use, and barriers to the use, of non-medication pain therapies and to identify the demographic and clinical correlates of different non-opioid pain treatments.Methods The study was performed on a cohort (n = 1514) of people prescribed pharmaceutical opioids for chronic non-cancer pain (CNCP). Participants reported lifetime and past month use of healthcare services, mental and physical health, pain characteristics, current oral morphine equivalent daily doses and financial and access barriers to healthcare services.Results Participants reported the use of non-opioid pain treatments, both before and after commencing opioid therapy. Services accessed most in the past month were complementary and alternative medicines (CAMs; 41%), physiotherapy (16%) and medical and/or pain
specialists (15%). Higher opioid dose was associated with increased
financial and access barriers to non-opioid treatment. Multivariate
analyses indicated being younger, female and having private health
insurance were the factors most commonly associated with accessing
non-opioid treatments.Conclusions Patients on long-term opioid therapy report using multiple types of pain
treatments. High rates of CAM use are concerning given limited evidence
of efficacy for some therapies and the low-income status of most people
with CNCP. Financial and insurance barriers highlight the importance of
considering how different types of treatments are paid for and
subsidised.What is known about the topic? Given concerns
regarding long-term efficacy, adverse side-effects and risk of misuse
and dependence, prescribing guidelines recommend caution in prescribing
pharmaceutical opioids in cases of CNCP, typically advising a
multidisciplinary approach to treatment. There is a range of evidence
supporting different (non-drug) treatment approaches for CNCP to reduce pain
severity and increase functioning. However, little is known about the
non-opioid treatments used among those with CNCP and the demographic and
clinical characteristics that may be associated with the use of
different types of treatments. Understanding the use of non-drug therapy
among people with CNCP is crucial given the potential to improve pain control for these patients.What does this paper add?
The present study found that a wide range of non-opioid treatments was
accessed by the study sample, both before and after commencing opioids,
indicating that in this sample opioids were not the sole strategy used
for pain
management. The most common treatment (other than opioids) was CAM,
reported by two-fifths of the sample. Having private health insurance
was associated with increased use of non-opioid treatments for pain,
highlighting the importance of considering how treatments are paid for
and potential financial barriers to effective treatments.What are the implications for practitioners? Patients' beliefs and financial barriers may affect the uptake of different treatments. Many patients may be using complementary and alternative
approaches with limited evidence to support their use, highlighting the
need for clinicians to discuss with patients the range of prescribed
and non-prescribed treatments they are accessing and to help them
understand the benefits and risks of treatments that have not been
tested sufficiently, or have inconsistent evidence, as to their efficacy
in improving pain outcomes.
