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Examining the relationship between pain interference, pain intensity, and mental health symptoms among veterans receiving long-term opioid therapy for chronic noncancer pain in primary care

Amanda Kutz, PhD, Amber Martinson, PhD, Katherine Stratton, PsyD, Clayton Hamilton, PharmD, Julie Carney, RN, William Jacobson, RN, Katherine Sadler, RN, Tauna Thomas, RN, William Marchand, MD, Jamie Clinton-Lont, MS, CNP

Abstract


Objective: As part of the evaluation of the Whole Health Primary Care Pain Education and Opioid Monitoring Program (PC-POP), we examined the relationship between pain intensity, pain interference, and mental health symptoms among PC-POP enrollees.

Design/methods: Retrospective cohort study examining self-reported symptoms of pain intensity, pain interference, anxiety, depression, substance use, and quality of life. Data were retrieved through a combination of chart review and data extracted from the VA Informatics and Computing Infrastructure.

Setting: Veterans Health Administration Health Care System Primary Care service.

Subjects: Adult veterans with chronic noncancer pain receiving opioid therapy >3 months being managed in primary care and enrolled in PC-POP between August 1, 2018 and April 1, 2019.

Results: A total of 439 participants were included in the final analysis. Results showed that anxiety has a unique relationship to pain intensity and that depression and quality of life have unique relationships to pain interference when relevant covariates, eg, gender, age, pain diagnosis, and predictors are examined among this unique sample of veterans enrolled in a pain and opioid education and monitoring program.

Conclusions: Given that primary care is the dominant healthcare setting in which opioids are prescribed for chronic noncancer pain, further research is needed to examine factors that influence pain management in this setting. This study examined the role mental health factors have on pain intensity and pain interference among patients enrolled in an opioid monitoring program and found that anxiety and depression appear to uniquely predict how intensely and impactful these veterans experience their pain. This study extends the literature by examining such factors among a unique population that has yet to be studied and offers some recommendations for monitoring and practice.


Keywords


anxiety, depression, pain intensity, pain interference, chronic pain, opioid therapy, primary care, Veterans Affairs

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References


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DOI: https://doi.org/10.5055/jom.2021.0661

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