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Determining Pain Detection and Tolerance Thresholds Using an Integrated, Multi-Modal Pain Task Battery

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Concomitant medication among persistent opioid users with chronic non-malignant pain.

A Mellbye¹, K Svendsen, P C Borchgrevink

¹Department of Circulation and Medical Imaging, Pain and Palliation Research Group, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway. andrm@stud.ntnu.no

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Summary

Sixty percent of patients on long-term opioid therapy for chronic pain were prescribed benzodiazepines, contradicting treatment guidelines. This co-prescription may increase risks of problematic opioid use.

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Area of Science:

Pharmacology
Pain Management
Public Health

Background:

Recent guidelines advise against co-prescribing opioids with benzodiazepines for chronic non-malignant pain.
Non-opioid analgesics and co-analgesics are recommended for potential opioid-sparing effects.

Purpose of the Study:

To determine the 1-year prevalence of co-medication in persistent opioid users with chronic non-malignant pain.
To examine co-prescription patterns of benzodiazepines, hypnotics, non-opioid analgesics, co-analgesics, and antidepressants.

Main Methods:

Utilized data from the Norwegian Prescription Database for all outpatient drug dispensations in 2008.
Compared concomitant medication use in persistent opioid users against the general Norwegian population.

Main Results:

1.2% of Norwegian adults met criteria for persistent opioid use.
60% of persistent opioid users received benzodiazepines or related hypnotics regularly; 15% received high amounts of both.
62% received non-opioid analgesics, 47% antidepressants, and 33% antiepileptic drugs.

Conclusions:

A significant proportion (60%) of persistent opioid users are co-prescribed benzodiazepines or related hypnotics regularly.
This co-medication pattern conflicts with current pain management guidelines.
Such practices may elevate the risk of problematic opioid use among these patients.