Understanding opioid use for noncancer pain: a community pharmacy-based observational study of patient profiles and experiences.

Abstract

Opioids are widely prescribed for noncancer pain, yet patient characteristics and experiences remain poorly understood. We conducted an observational study in community pharmacies (Belgium) to describe patient profiles, explore initiation and follow-up, and assess treatment experiences. Data were collected primarily through a structured questionnaire. Overall, 1048 patients using opioids for noncancer pain participated (64.4% female; mean age, 59.0 years). Most were treated with weak opioids, although nearly 30% received strong opioids. Pain intensity was high (median score of 7 [interquartile range 2] on 0-10 Numeric Rating Scale), with substantial interference in daily activities. Opioid therapy was predominantly initiated for chronic pain, most often low back pain. Although most patients were informed about drug strength, far fewer received information on adverse effects. In 61% of cases, continued need for opioids was discussed; agreements on treatment duration were established in about 40%. Despite high pain burden, satisfaction with opioid effect and perceived need for opioids were high. In multivariable analysis, lower satisfaction was associated with higher pain intensity, depression, longer pain duration, and use of strong opioids. In addition, long-term opioid use (≥3 months) was associated with low back pain, use of strong opioids, and longer pain duration. Forty percent had attempted discontinuation, often on their own initiative; nearly half of these attempts involved abrupt cessation. Opioid therapy for noncancer pain is commonly initiated for chronic low back pain and accompanied by high perceived need. Our findings highlight gaps in counseling and follow-up, underscoring the need for patient-centered strategies to optimize opioid use.