Chronic pain among primary fentanyl users: The concept of self-medication

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain Pub Date : 2024-11-06 DOI:10.1002/ejp.4753

Jane J. Kim, Dianah Hayati, Milad Zamany, Fiona Choi, Kerry Jang, Martha Ignaszewski, Pouya Azar, Michael Krausz

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Abstract

Background

Chronic pain is among the leading causes of disability worldwide, of which only a small percentage of patients receive adequate treatment for. Non-prescribed opioid analgesics are commonly sought out in effort to alleviate unrelieved pain. This study assesses the prevalence and correlates of chronic pain among primary fentanyl users.

Methods

A cross-sectional and structured survey was conducted with 200 adults who reported fentanyl as their drug of choice from a Vancouver acute care hospital. Presence and levels of chronic pain were determined through self-report.

Results

The majority of participants (n = 130, 72.6%) reported having chronic pain in the past 6 months, with the mean level of pain on a typical day to be 7.6 out of a scale of 10 (SD = 1.9). Majority (n = 85, 65.4%) reported using street opioids to self-medicate, while only 9 (6.9%) reported that their chronic pain was unrelated. Regression analysis indicated that increasing age and co-use of cannabis and opioids were independent associated factors of chronic pain. Higher levels of reported pain on a typical day were further associated with age and self-medication.

Conclusions

The findings of this study demonstrate a significant association between self-medication and chronic pain among primary fentanyl users in British Columbia. For these individuals, inadequate pain relief may drive continued opioid use, which in turn may increase risks of treatment discontinuation and overdose. Appropriate pain management strategies are crucial to avoid opioid misuse and decrease the large societal burden caused by chronic pain.

Significance

Our work points to the high prevalence of self-reported chronic pain among individuals who primarily use fentanyl. Among those with self-reported fentanyl use and chronic pain, self-medication with street opioids was found to be common and associated with higher reported pain levels on a typical day. This highlights the need for pain management strategies to be integrated into opioid dependence treatment and more research in the overlap of pain and fentanyl use.

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初级芬太尼使用者的慢性疼痛：自我药疗的概念。

背景：慢性疼痛是导致全球残疾的主要原因之一，其中只有一小部分患者得到了适当的治疗。患者通常会寻求非处方阿片类镇痛药来缓解无法缓解的疼痛。本研究评估了初级芬太尼使用者中慢性疼痛的发生率和相关性：我们对温哥华一家急症护理医院的 200 名成人进行了横断面结构性调查，这些人称芬太尼是他们的首选药物。通过自我报告确定慢性疼痛的存在和程度：大多数参与者（n = 130，72.6%）表示在过去 6 个月中有过慢性疼痛，在 10 分制的评分中，平均每天的疼痛程度为 7.6（SD = 1.9）。大多数人（85 人，65.4%）报告说他们使用街头阿片类药物进行自我治疗，只有 9 人（6.9%）报告说他们的慢性疼痛与此无关。回归分析表明，年龄增加以及同时使用大麻和阿片类药物是慢性疼痛的独立相关因素。平日报告的疼痛程度较高与年龄和自我药物治疗进一步相关：本研究结果表明，在不列颠哥伦比亚省的芬太尼初级使用者中，自我药疗与慢性疼痛之间存在显著关联。对于这些人来说，疼痛缓解不足可能会促使他们继续使用阿片类药物，这反过来又会增加中断治疗和用药过量的风险。适当的疼痛管理策略对于避免滥用阿片类药物和减轻慢性疼痛造成的巨大社会负担至关重要：我们的研究表明，在主要使用芬太尼的人群中，自我报告的慢性疼痛发生率很高。在自我报告使用过芬太尼并患有慢性疼痛的人群中，发现使用街头阿片类药物进行自我治疗的情况很普遍，并且与报告的平日疼痛程度较高有关。这凸显了将疼痛管理策略纳入阿片类药物依赖治疗的必要性，以及对疼痛和芬太尼使用重叠问题进行更多研究的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Pain 医学-临床神经学

CiteScore

7.50

自引率

5.60%

发文量

163

审稿时长

4-8 weeks

期刊介绍： European Journal of Pain (EJP) publishes clinical and basic science research papers relevant to all aspects of pain and its management, including specialties such as anaesthesia, dentistry, neurology and neurosurgery, orthopaedics, palliative care, pharmacology, physiology, psychiatry, psychology and rehabilitation; socio-economic aspects of pain are also covered. Regular sections in the journal are as follows: • Editorials and Commentaries • Position Papers and Guidelines • Reviews • Original Articles • Letters • Bookshelf The journal particularly welcomes clinical trials, which are published on an occasional basis. Research articles are published under the following subject headings: • Neurobiology • Neurology • Experimental Pharmacology • Clinical Pharmacology • Psychology • Behavioural Therapy • Epidemiology • Cancer Pain • Acute Pain • Clinical Trials.