Anxiety and Fear Avoidance Beliefs and Behavior May Be Significant Risk Factors for Chronic Opioid Analgesic Therapy Reliance for Patients with Chronic Pain—Results from a Preliminary Study

• Published in: Pain medicine (Malden, Mass.) Mass.), 2021-09, Vol.22 (9), p.2106-2116
• Main Authors: Silva, Marcelina Jasmine, Coffee, Zhanette, Yu, Chong Ho, Martel, Marc O
• Format: Article
• Language: English
• Subjects: Analgesics; Anxiety; Avoidance behavior; Chronic pain; Co-Morbid Pain & Substance Use Disorders Section; Complications and side effects; Drug therapy; Electronic medical records; Fear; Health aspects; Morphine; Narcotics; Opioid receptors (type mu); Pain; Pain management; Patients; Psychological aspects; Questionnaires; Risk factors
• ISSN: 1526-2375; 1526-4637
• DOI: 10.1093/pm/pnab069

Abstract Objective To describe differences between patients with chronic, non-cancer pain (CNCP) who were successfully able to cease full mu agonist chronic opioid analgesic therapy (COAT), and those who exhibited refractory COAT reliance, among those who participated in a multidisciplinary program designed for COAT cessation. Design A retrospective review of electronic medical records (EMR) data was organized for preliminary analysis. Setting A multicenter private practice specializing in CNCP, which received patient referrals from the surrounding geographical area of primary and specialty care offices in Northern California. Subjects Data from 109 patients with CNCP who participated in a multidisciplinary program to cease COAT between the dates of October 2017 to December 2019 were examined. Methods EMR data, pre-COAT cessation, of oral morphine milligram equivalence (MME) and validated questionnaire responses assessing anxiety and fear-based beliefs and behavior, as well as opioid misuse, were extracted and compared between those who successfully ceased COAT and those who did not. Results Patients who were unsuccessful at COAT cessation reported significantly higher Fear Avoidance Beliefs Questionnaire (FAB) scores. No significant differences were found based on incoming MME amounts, Current Opioid Misuse Measure (COMM) or Tampa Scale of Kinesiophobia (TSK) scores. Pain Catastrophizing Scale (PCS) scores showed a split pattern with unclear significance. Conclusions Results suggest that fear avoidance beliefs and behavior, as measured by the FAB, play a significant role in refractory COAT reliance for patients with CNCP.