The purpose of this study was to examine the levels of pre-treatment opioid use as a predictor of success in a multidisciplinary pain center. Much of the research on chronic pain has demonstrated that multidisciplinary pain rehabilitation programs are beneficial and cost-effective for the reduction of pain and improvement of functional outcomes (Gatchel & Turk, 1999). However, the use of opioid medication to treat chronic pain is often a first and common intervention; although, its long-term effectiveness to manage pain remains controversial (Grady, Berkowitz, & Katz, 2011; Portenoy, 1996; Turk, 1996). Over the course of the last 5-10 years, a few studies have emerged examining if patients using opioids at the start of a multidisciplinary pain program achieve poorer outcomes in comparison to those who are not using opioids. Results have been variable across studies and specific measures. The majority of the studies examined opioid use as a dichotomous variable, use or no use, and all but one study mandated opioid withdrawal during treatment. The current study examined opioid use as a dichotomous use or no use variable but also divided patients into five subgroups in order to examine varying dosage levels on treatment outcome. Furthermore, the current study examined the effects of continued opioid use on outcomes across domains of functioning.
The findings of this study demonstrated that participants who entered multidisciplinary chronic pain treatment on lower levels of opioids demonstrated greater improvement in depression compared to patients on higher levels of pre-treatment opioids. However, across all other measures, patients who reported pre-treatment opioid use showed similar benefits from multidisciplinary pain treatment compared to patients who reported no pre-treatment opioid use. Pre-treatment opioid use was found to be a successful predictor of post-treatment BDI, PASS, and PSEQ scores and those patients who decreased their opioid use during treatment demonstrated significantly greater improvement on measures of anxiety and self-efficacy compared to those who maintained their dosage. Additionally, it is important to note that opioid users did not report decreased pain levels or improved functioning at the start or end of treatment, which would have been expected for patients using opioids to control pain. Future recommendations include replicating the study within a larger and more diverse population, randomly assigning patients to opioid use conditions, and implementing objective measurements of current opioid use at the beginning of treatment and throughout the program.
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