Patient Activation is Associated With Positive Attitudes Toward Pain Medications.

Abstract

Purpose: To examine the associations between patient activation and pain-medication attitudes and long-term opioid use among patients with chronic low back pain (cLBP).

Design: Cross-sectional study with longitudinal follow-up.

Methods: We surveyed participants at 30 days, 3 months, 6 months, and 12 months. The survey included the Patient Activation Measure, Short Barriers Questionnaire-Taiwan (pain-medication attitudes), Oswestry Disability Index (ODI) (pain-related disability), and long-term opioid use.

Results: A total of 1,055 patients was included in the main analysis. Patients in the low-activation group were more likely to report opioid use within 30 days and at 3 months and to endorse greater pain-related disability. Patients with high activation were more likely than patients with low activation to disagree with the beliefs that pain medication cannot control their pain, that good patients avoid talking about pain, and that pain medication should be saved.

Conclusions: High patient activation was associated with decreasing short- and long-term opioid use and less maladaptive attitudes toward pain medications. Participants with long-term opioid use were more likely to have maladaptive attitudes toward pain medications. Interventions that deploy multi-modal nonpharmacological or psychosocial approaches (e.g., motivational interviewing), in addition to collaboratively setting goals, managing expectations, and improving medication knowledge, are needed to improve patient activation among patients with cLBP.

Implications for nursing education, practice, and research: Motivational interviewing, collaborative goal setting, and improving medication knowledge and managing pain expectations may help improve activation in this population.