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Chronic Pain Patients’ Perception of Opioids May Determine How Well the Medications Work

Study shows that preconceived notions may divide patients and interrupt care

A PPM Brief

A recent trial conducted by the Veterans Administration (VA), Strategies for Prescribing Analgesics Comparative Effectiveness (SPACE),1 examined pre-existing perceptions about pain medications among patients with chronic musculoskeletal pain, and how these perceptions relate to their experiences with these medications.

"Given evidence suggesting that treatment expectations can influence treatment response, we sought to gain a more complete understanding of the potential role of expectations and perceptions of opioids held by patients with chronic back, hip and knee pain," said author Marianne Matthias, a research scientist at the VA Center for Health Information and Communication at the Richard L. Roudebush VA Medical Center and with the Regenstrief Institute's Center for Health Services Research.

The randomized controlled trial compared the benefits and harms of opioid versus non-opioid medications over 12 months for chronic musculoskeletal pain. Results demonstrated that opioid medications were not better at improving pain that interfered with walking, work, or sleep over 12 months for individuals with chronic back pain or arthritis in their hips or knees compared to non-opioid medications. Researchers also reported that adverse medication-related symptoms were more common in the patients who took opioids.

The patient-provider relationship was another important factor in perception, as SPACE’s patient-pharmacist telecare collaborative management care model, for example, may have had an important influence on patient's perceptions of and responses to pain medications. "We found that personalized care by someone who cares — in this case by a pharmacist — often meant more to patients than the actual medications they were taking,” Dr. Matthias said. “Patients seem to value working with someone who cares about them and can help to meet their physical and emotional needs."

Finally, researchers investigated patients’ experience with the SPACE trial experience itself, which, despite strongly held beliefs about opioid and non-opioid medications, patients were often surprised by their results.  Said one subject after switching from opioid to non-opioid treatment: "I was expecting it not to be 180-degree turn because I went from being just miserable every day to being just, for the most part, happy. I can basically just bounce right out of bed. I assumed…opioids were powerful. So they were necessary for extreme pain when that's not the case. So I do have a lot more respect…for non-opioids.”

Last updated on: August 23, 2018
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