Concern over drug cocktails used in chronic non-cancer pain


By Mardi Chapman

11 Nov 2021

Many Australians taking opioids long-term for chronic non-cancer pain (CNCP) also use non-opioid pharmacological and non-pharmacological treatments outside clinical guidelines.

The Pain and Opioids IN Treatment study comprised adults receiving opioids for CNCP for more than 6 weeks from community pharmacies who were then followed up annually for four years.

Data from 1,334 participants in the study showed back pain (79.2%) and arthritis (66.6%) were the most common pain conditions.

Over the study period, almost all patients reported at least 12 months of non-opioid drugs including paracetamol (79.8%) and antidepressants (66.2%).

Similarly, the most common medicines reported in the previous 30 days were paracetamol (68.4%), antidepressants (64.5%), sedative hypnotics (48.3%), gabapentinoids (45.8%), and NSAIDs (34.3%).

“Consistency between 12-month and 30-day use indicates potential regular and sustained medicines use between these time periods. Despite this, most participants continued to report moderate pain severity and interference scores throughout the 4-year period, highlighting the ongoing complexity of CNCP management and that many individuals continue to live with pain despite engaging with treatment,” the study said.

The study, published in Pain, said NSAIDs were commonly used consistently despite guidelines recommending short-term use of these medicines because of the risk of AEs such as gastrointestinal bleeding.

And there were risks in taking many of the other non-opioid medicines including psychotropics, gabapentinoids, pregabalin and sedative-hypnotics.

Use of a non-pharmacological treatment was also common (91.8% over 12 months; 66.1% in the last 30 days), variously delivered by medical specialists, physiotherapists, surgeons, psychologists, and pain management programs.

“Given the stronger evidence of long-term benefits and improved functional outcomes compared with medicines, it is suggested that expanding multidisciplinary pain management may be an important strategy to reducing over-reliance on medicines that expose individuals to ADEs.”

The study found private health insurance was associated with the use of physical and specialised non-pharmacological treatments.

Access to effective pain management strategies therefore remained a significant problem for many people with CNCP, even within the context of a universal healthcare scheme.

The investigators, from the National Drug and Alcohol Research Centre, concluded that more research was required to further explore how patients and providers choose treatments and to evaluate strategies to address barriers to treatment use.

“Ongoing NSAID and sedative-hypnotic use are not concordant with CNCP guidelines, as was the limited use of pain management programs,” they said.

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