Medication Compliance in Patients with Chronic Pain

Abstract

Background: Despite hints about the high incidence of pain patients misreporting their pain medication use, there are only a few non-controlled studies on the topic that focus solely on opioids. Objective: Using toxicological analyses in a cross-sectional study, we investigated patients’ reliability regarding their report of any current pain medication use. Study Design: A cross-sectional study. Setting: A comprehensive pain center and a surgical unit of a German University Hospital. Methods: Consecutive outpatients at their first visit to the pain clinic (PG, n = 243) and pre-surgical control patients (SG, n = 100) suffering from pain reported on their current pain medication. The patients’ reports were verified in serum and urine using specific toxicological methods. Two types of noncompliance were defined: under-reporting (detection of non-reported substances) and overreporting (reported substances undetectable). The impact of clinical parameters on compliance was investigated using binary logistic regression. Results: The incidence of noncompliance was significantly higher in the PG (43.3%) than in the SG (24%; P < 0.05). Under-reporting occurred similarly in both groups (31% PG; 23% SG), whereas over-reporting predominantly appeared in the PG (11% vs. 2%; P < 0.05). Opioids were not most frequently under-reported, but the highest proportion of under-reported drugs (underreported in relation to detection incidence) was found for non-opioid analgesics (NSAIDs: 29% PG; 25% SG; other: 42% PG; 32% SG) and psychotropic drugs (35% PG; 53% SG). In the PG, logistic regression revealed high depression scores to be predictive for noncompliance (odds ratio 2.12). Limitations: Due to lack of a structured follow-up interview motives of under- and over-reporting stay speculative. Conclusions: Under-reporting of non-opioid analgesics is the main type of noncompliance, a disquieting fact in light of their toxicity and adverse effects. Further research is required in terms of drug assessment and compliance improvement strategies in pain clinics; therefore, toxicological monitoring is indispensable. Clinical Trial: NCT01625065; Medi-3889-10 Key words: Medication compliance, adherence, chronic pain, toxicological analyses, urine drug testing, NSAID, opioids

Selective androgen receptor modulator microparticle formulation reverses muscle hyperalgesia in a mouse model of widespread muscle pain

“…68 Several studies report nonadherence to prescribed medication in individuals with chronic pain and have indicated various reasons for nonadherence, including side effects, dosing frequency, polymedication, and both high and low pain intensity. 44,69,76 Injectable polymeric long-acting formulations are clinically available, safe, and have the potential to overcome adherence issues that result from repeated administration of medications. 1,65,66,68,85 Thus, we developed a novel, injectable, long-acting SARMloaded microparticle formulation that can be injected subcutaneously to provide sustained release and maintain effective plasma levels of SARM over a long period, thus eliminating the need for daily administrations.…”

“…35,39 Furthermore, repeated oral drug administration leads to fluctuations in drug plasma levels, resulting in subtherapeutic or toxic drug concentrations, which can produce treatment failure or adverse effects, respectively. 44,61,69,76 One way to overcome poor adherence and fluctuating drug concentrations of orally delivered drugs is with long-acting, injectable microparticle formulations. These formulations allow for controlled drug delivery by slowly releasing encapsulated drug over time to provide steady plasma levels of drug concentrations following a single administration.…”

“…Adherence to daily administration of prescribed medications is poor with roughly 50% of individuals with chronic diseases, including chronic pain, being nonadherent. 11,38,44,69,76 Medication noncompliance is estimated to cost the United States $100 billion per year in increased healthcare costs, increased morbidity, and death. 64 Prescription adherence of pharmacological agents improves with less frequent dosing.…”

Pragmatic trials of pain therapies: a systematic review of methods

“…The main criticism of traditional RCTs concerns the lack of generalisability of research findings due to key aspects of the trial design, 98 including exhaustive exclusion criteria (comorbidity, polypharmacy, psychiatric illness, and substance use disorder), 4,98,100,107,121 trial populations differing from the general patient population, 72,79 and unrealistic treatment compliance. 24,60,73 Maybe most importantly, what matters to a patient may not have been assessed in an RCT: To be relevant for clinical decision making, statistical changes in outcome measures need to be reflected in clinically noticeable and personally valuable changes in symptoms, quality of life, or disease risk. 25,31,112,120 Even so, the time horizon of a patient's decision is rarely encapsulated by common RCT follow-up periods that are usually 6 months or less.…”

Design and preliminarily validation of a tool to assess the impact of chronic non‐cancer pain on people’s daily life in Spanish‐language: PAIN_Integral Scale©

“…The available evidence shows that a correct comprehensive assessment of CNCP improves it in terms of pain intensity control, but mainly in terms of psychological and social aspects (Cáceres‐Matos, Gil‐García, Barrientos‐Trigo, et al, 2020). It is well‐known that CNCP can impact different areas such as the ability to carry out self‐care (Kovačević et al, 2018), mobility (Ferrer‐Peña et al, 2016), sleep quality (Haack et al, 2020), compliance with treatment (Kipping et al, 2014), proactivity (Norrefalk, 2011), resilience (Hemington et al, 2018), social support (Cabrera‐León et al, 2018; Humberto & Gerard, 2019), hopelessness (Eaves et al, 2016) and/or pain catastrophizing (Akbari et al, 2016).…”