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ABSTRACT

Little is known about the impact of long-term opioid use in adults with chronic low back pain (CLBP). Objective: To facilitate improved patient care by expanding clinician understanding of the impact of opioid medications on the lives of patients with CLBP. Study group: Adults with CLBP (≥ 3 months) treated with daily opioids (≥ 15 mg. morphine equivalent dose). Methods: Qualitative analysis of responses to the question, “How do your opioid or narcotic pain medications impact your life?” from interviews conducted before and after interventions of either an 8-week mindfulness meditation- or cognitive behavior therapy (CBT)-based group therapy course. Responses were segmented by topical or conceptual speech unit, and analyzed using qualitative thematic analysis. Thematic saturation was achieved with 109 participants. Descriptive statistics were used to characterize demographic data. Results: Most participants were white (79.8%), female (62.3%), and married (51.4%), with an average age of 59.3 years. Nearly all participants (98.2%) rated severe or worse disability. Key take-aways that emerged from the nine themes identified include the extent to which patients are fearful of open communication with their clinician, the limited efficacy of pain regimens, and the degree to which many participants need opioid medications to function, but would prefer to not be taking them. Conclusions: As patients grapple with changing guidelines, public opinion, medication prices, and care “management” by insurance companies, it is incumbent upon clinicians to remember that these patients can face profound negative consequences from disruptions in their care and medication regimen.

Keywords: Chronic pain, chronic low back pain, opioid, narcotic, quality of life, United States