Assessment Of Pre-, Post-, And Change In Opioid Use: Evaluation Of Hydrocodone As Part Of Functional Restoration Treatment In A Chronic Disabling Occupational Musculoskeletal Pain (CDOMP) Population
Worzer, Whitney E.
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The current study examines the relationship between pre-treatment, post-treatment, and change in opioid use among 1,601 chronic pain patients who participated in a functional restoration program, along with an additional investigation of pre-treatment hydrocodone use. Patients received an initial evaluation prior to treatment, including a physical examination, medical history, disability assessment, and psychological intake. In the initial phase of treatment, patients consented to be weaned from opiate medications. Assessments were repeated at program completion and structured telephone interviews were conducted at one-year post-treatment to evaluate socioeconomic outcomes. A substantial portion of patients entering the program reported opioid use upon admission (n=1054; 65.8%), and patients were divided into 5 subgroup: None (0 mg, n=547), PRN (<15mg, n=226), Low (16-30mg, n= 252), Moderate (31-60 mg, n=273) and High (>61mg) after total daily morphine equivalent (ME) doses were calculated. Pre-treatment opioid dose, post-treatment opioid dose, and change in level of opioid use all produced significant findings. Demographic differences were found related to level of opioid use and rate of program completion, area of injury, length of disability, pre-treatment surgery, and differences in racial groups. An inverse relationship was found between program completion and level of pre-treatment opioid use. One particular area of interest revealed significant findings related to assessing Patient Reported Outcomes (PROs). Significant differences were identified in self-reported measures of psychosocial distress as they relate to opioid use at both at pre-treatment and post-treatment after controlling for demographic differences. Overall, these findings suggest that patients on PRN doses of opioids at either pre-and/or post-treatment report similar levels of pain intensity, change in pain intensity, depressive symptoms, perceived disability, and insomnia. Further studies would aid in the understanding of the connection between higher levels of self-reported distress and their association with higher levels of opioid use. Additionally, when analyzing one year socioeconomic outcomes such as work return, work retention, and healthcare utilization, opioid use at pre-treatment was found to be a predictor of work return, but perhaps a better predictor of work retention. While posts-treatments level of opioids for successful program completers did not demonstrate significant differences in work return and work retention rates, healthcare utilization at one-year was found to be significantly associated with post-treatment level of opioid use. Current health care cost require attention to these findings in that individuals who complete a functional restoration program and maintain opioid use may have similar occupational outcomes however, healthcare utilization is significantly greater for chronic pain patients who complete treatment on higher doses of opioid medications.