Experiences of patients requiring strong opioid drugs for chronic non-cancer pai

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Br J Gen Pract. 2007 Feb;57(535):101-8.

Experiences of patients requiring strong opioid drugs for chronic

non-cancer pain: a patient-initiated study.

Blake S, Ruel B, Seamark C, Seamark D.

The Honiton Group Practice, Honiton.

BACKGROUND: Chronic non-cancer pain is an increasing problem in

health care. This study was initiated by a patient wanting to

discover more about the experiences of other patients requiring

strong opioid analgesia for such pain.

AIM: To determine the attitudes and experiences of patients

receiving long-term strong opioid medication for chronic non-cancer

pain in primary care. Design of study: Qualitative study using

interpretative phenomenological analysis.

SETTING: A semi-rural general practice in southwest England.

METHOD: The study data came from a focus group and 10 individual

patient interviews. A patient researcher was involved in the design,

conduct, and analysis of the project.

RESULTS: The impact of pain affected participants in every aspect of

their daily lives. Attitudes to strong opioid medication were both

positive and negative. Concerns about starting medication usually

centred on fears of addiction, being seen as an addict, or that the

patients may have a more serious condition than they had previously

thought. However, these fears were tempered by an appreciation of

the benefits that strong opioids brought in terms of pain relief and

consequent gains in a nearer-to-normal existence. The data did not

produce any evidence of addictive behaviour or of tolerance despite

these initial fears. Patients adopted a trade off approach,

balancing pain relief with medication side effects, accepting more

pain for a reduction in sedation and nausea. All patients described

coping strategies they developed themselves and learned from outside

influences, such as pain clinic courses and support from the GP.

There was realism that total pain relief was not possible, but that

a balance could be struck.

CONCLUSION: Chronic non-cancer pain is associated with high levels

of distress and psychosocial impairment. Patients in this study

appreciated the benefits of strong opioid medication, having come to

terms with fears of addiction and learned coping strategies. These

findings should encourage GPs to consider strong opioid medication

for patients with severe chronic pain in line with published

evidence-based guidelines.