People with chronic non-cancer pain receiving chronic morphine treatment at the Chronic Pain Management Clinic of Groote Schuur Hospital: a cross-sectional survey of characteristics and satisfaction with treatment

Moodley, Prenisha

People with chronic non-cancer pain receiving chronic morphine treatment at the Chronic Pain Management Clinic of Groote Schuur Hospital: a cross-sectional survey of characteristics and satisfaction with treatment

Thesis / Dissertation

2023

Abstract

Introduction Chronic pain is an ever-growing burden whose complex nature and interpatient variability make management challenging. Evidence for the use of chronic opioids for the treatment of chronic non-cancer pain is controversial with limited data to support its long-term efficacy. The use of opioids both acutely and chronically is associated with several risks. In this study, we assessed the characteristics of chronic non-cancer pain patients attending the Chronic Pain Management Clinic (CPMC) of Groote Schuur Hospital (GSH) and evaluated their satisfaction with treatment. Methods A cross-sectional observational study of chronic non-cancer pain patients attending the CPMC who are on chronic morphine (> 3 months). We collected data on patient characteristics, pain intensity, mental health status, health-related quality of life, central sensitization, and satisfaction with their treatment. Results The majority of our patients were older, overweight, currently unemployed, and from low socioeconomic status. Patients reported an overall severe pain severity score of 7 (IQR: 4.5- 8.5) with a moderate pain interference score of 4.85 (IQR: 2.4-7.5), where the maximum score is 10 for both categories. All patients had scores suggestive of moderate to severe childhood trauma on the Childhood Trauma Questionnaire and all, but one patient was at risk of anxiety/depression based on their scores on the Hospital Anxiety and Depression Scale. Health-related quality of life, as measured by the EQ-5D overall index, was high (median 1, IQR: 0.87-1) but VAS scores for the state of health today were notably low (median 50, IQR: 40-50). Most patients reported an improvement in their pain, mood, work- v related activities, physical activities, and overall well-being since starting treatment with morphine. However, one patient reported no change, with another patient reporting much worse pain and physical activity since initiating morphine therapy. Overall, most patients did not receive alternative non-pharmacological therapies, and none of the patients participated in the Pain Education Empowerment Programme. Conclusion The use of chronic morphine did not significantly lower pain severity or pain interference with function in our patients. Furthermore, we found these patients to be at a higher risk of developing anxiety or depression. Although patients reported high overall HRQoL as suggested by high EQ-5D utility scores, their individual VAS scores were concerningly low. Their older age, lower socioeconomic status, and disability may be determinant factors in this discrepancy.

Keywords

Anaesthesia and Perioperative Medicine

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