Persistent analgesic use and the association with chronic pain and other risk factors in the population—a longitudinal study from the Tromsø Study and the Norwegian Prescription Database

Samuelsen, Per-Jostein; Svendsen, Kristian; Wilsgaard, Tom; Stubhaug, Audun; Nielsen, Christopher Sivert; Eggen, Anne Elise

doi:10.1007/s00228-016-2056-7

Cited by 15 publications

(21 citation statements)

References 39 publications

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“…A first questionnaire was sent out by post with the invitation letter approximately two weeks before attendance. A second questionnaire, containing follow-up questions, was given at attendance, and it could be either filled out at the location or sent in afterwards by post [12]. …”

Section: Methodsmentioning

confidence: 99%

“…Analgesics included were: a) Non-steroidal anti-inflammatory drugs (NSAIDs, ATC group M01A, excluding M01AX05 glucosamine), b) opioids (N02A), or c) other analgesics and antipyretics (N02B), which in practice consisted of paracetamol (acetaminophen). Atypical/adjuvant analgesics constituted only a small fraction of the total prescription volume and were not included due to ambiguous indication for use, e.g., treatment of depression or pain [12]. Briefly, we collapsed the aforementioned analgesic groups into a combined measure of analgesic use and identified persistent treatment episodes of analgesics.…”

Section: Methodsmentioning

confidence: 99%

“…Briefly, we collapsed the aforementioned analgesic groups into a combined measure of analgesic use and identified persistent treatment episodes of analgesics. Prescriptions dispensed within 180 days of one another belonged to the same treatment episode; subjects were defined as being under persistent use if the treatment episode lasted 90 days or more and the proportion-of-days-covered (PDC) with analgesics was 40% or higher [12]. In this context, the PDC was calculated on the basis of the DDD and reflects a measure of intensity of use.…”

Section: Methodsmentioning

confidence: 99%

“…In this regard, there has been a growing interest in mechanism-based treatment of pain, i.e., finding and treating potential treatment responders on the basis of the pathophysiological pain mechanisms involved [8, 9], and whether experimental pain tests can be used to predict if a patient would respond to an analgesic [10, 11]. We have previously shown that the prevalence of persistent prescription (Rx) analgesic use is only ten percent among those reporting chronic pain, and we suggest that this group may represent those who benefit from long-term treatment and have not discontinued due to adverse effects [12]. Moore et al point out that if the patient responds to treatment, the benefit is often long-lasting [4].…”

Section: Introductionmentioning

confidence: 99%

“…To achieve these aims, we linked the largest pain sensitivity study to date, the Tromsø 6 study, with eight years of individual-level dispensing data from the Norwegian Prescription Database (NorPD). This study is based on methods and study design as previously reported by us [12]. …”

Section: Introductionmentioning

confidence: 99%

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Pain sensitivity and analgesic use among 10,486 adults: the Tromsø study

Samuelsen

Nielsen

Wilsgaard

et al. 2017

BMC Pharmacol Toxicol

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BackgroundIncreased pain sensitivity is a putative risk factor for chronic pain and consequently for analgesic use. Conversely, analgesic use may be a cause of increased pain sensitivity, e.g., through opioid-induced hyperalgesia. We aimed to study the association between pain sensitivity and analgesic use in a general population, and to test the hypothesis that increased baseline pain sensitivity is a risk factor for future persistent analgesic use.MethodsThe Tromsø Study (2007–08), a population-based health study, was linked with eight years of prescription data from the Norwegian Prescription Database. The cold pressor test was completed in 10,486 participants aged 30+ years, and we used cold pressor endurance time as a proxy measure of pain sensitivity. Cross-sectional associations with different measures of analgesic use were assessed. Furthermore, a cohort of 9,657 persons was followed for 4.5 years.ResultsIn the cross-sectional analysis, increased pain sensitivity was associated with analgesic use; regular users of opioids alone were more pain sensitive than regular users of non-opioid analgesics. Increased baseline pain sensitivity was a risk factor for persistent analgesic use, i.e., using non-steroidal anti-inflammatory drugs, paracetamol, or opioids for ≥ 90 days and proportion-of-days-covered ≥ 40% (HR = 1.22, 95% CI 1.06-1.40), although not statistical significant after confounder adjustment.ConclusionsIncreased pain sensitivity was associated with analgesic use in general, and reduced pain tolerance was found for both opioid and non-opioid analgesic users. The data suggest that hyperalgesia is an effect of analgesics, whereas pain tolerance has little impact on future analgesic use.Electronic supplementary materialThe online version of this article (doi:10.1186/s40360-017-0149-2) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pain sensitivity and analgesic use among 10,486 adults: the Tromsø study

Samuelsen

Nielsen

Wilsgaard

et al. 2017

BMC Pharmacol Toxicol

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Correlates of chronic pain onset and recovery in the CoLaus cohort

Dirupo,

Rossel,

Fournier

et al. 2024

European Journal of Pain

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BackgroundOnly few previous cohort studies examined simultaneously predictors of chronic pain (CP) onset and recovery. Furthermore, these studies used various sociodemographic and pain‐related characteristics, without standardized measures of sleep and depression. The present study aimed at expanding and strengthening these findings in a large Swiss population.MethodsWe analysed data from a longitudinal cohort (n = 4602) collected at two time points separated by 5 years in Lausanne, Switzerland. We studied through two independent multivariable logistic regression models, the predictors of CP onset and recovery, including socio‐demographic data as well as standardized measures of sleep and mood.ResultsChronic pain was reported by 43.1% and 44.4% of participants, with 11.6% at the second follow‐up reporting moderate or intense pain. Neuropathic pain, regardless of intensity, had a more negative impact on quality of life. An inferential model (n = 1331) identified the male sex as predictive for recovering from CP. Older age, being overweight or obese (compared to normal weight), higher depression scores and pain medication intake were predictive for sustained pain at the second follow‐up. A second model (n = 1886) identified being overweight or obese (compared to normal weight), low quality of sleep and being a former smoker (compared to a non‐smoker) as predictive for developing CP, while the male sex was lowering the risk.ConclusionsWhile sex and weight are associated with both recovery and new CP onset, separate variables also need to be considered in these processes, underlining specific factors to be addressed, depending on the context, whether preventive or therapeutic.Significance StatementMultivariable models in a Swiss cohort (N = 4602) associate male sex, not taking pain medication, normal weight, lower depression scores and younger age with recovery from chronic pain, while females, obese or overweight, having worse sleep and former smokers are associated with onset of new chronic pain. These common and separate factors need to be considered in treatment and prevention efforts.

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The Challenges of Treating Sciatica Pain in Older Adults

Ferreira

McLachlan

2016

Drugs Aging

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Sciatica is a debilitating condition affecting approximately 25 % of the population. Typically, the patient will complain of lower limb pain that is more severe than pain in the lower back, usually accompanied by numbness and motor weakness. Most international guidelines recommend pharmacological management for the pain relief of sciatica, including paracetamol, non-steroidal anti-inflammatory drugs, opioid analgesics, anticonvulsants, and corticosteroids, among others. However, the evidence for most of these pharmacological options is scarce, and the majority of clinical trials exclude older patients. There is overall very limited information on the efficacy, safety, and tolerability of these medicines in older patients with sciatica. This review presents a critical appraisal of the existing evidence for the pharmacological treatment of sciatica, with a special focus on the older adult. The age-related changes in the health of older patients, as well as their impact on the response to pharmacological treatment, including polypharmacy, drug interactions, and drug-disease interactions, is also discussed.

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Persistent analgesic use and the association with chronic pain and other risk factors in the population—a longitudinal study from the Tromsø Study and the Norwegian Prescription Database

Abstract: This study showed a relatively low prevalence of persistent analgesic use and that the majority of persons reporting chronic pain do not use analgesics persistently.

Cited by 15 publications

References 39 publications

Pain sensitivity and analgesic use among 10,486 adults: the Tromsø study

Pain sensitivity and analgesic use among 10,486 adults: the Tromsø study

Correlates of chronic pain onset and recovery in the CoLaus cohort

The Challenges of Treating Sciatica Pain in Older Adults

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