Article

OBJECTIVE: To better define patients appropriate for opiate management for
chronic pain syndromes. DESIGN: Retrospective study of 65 patients with
noncancerous pain syndromes who were on or being considered for opiates and who
were transitioned into a structured outpatient clinic with close monitoring and
management. Noncompliance with this outpatient pain management program was the
primary outcome. Noncompliance was defined as (1) receipt of prescriptions from
providers outside of this clinic, (2) increase in medication dosage without
proper approval, (3) refusing toxicology screening on entrance into the program,
(4) negative toxicology tests for prescribed medications, (5) positive toxicology
tests for psychoactive medications not prescribed,
or (6) discovery on toxicology
tests of the presence of illicit substances. RESULTS: There were 24 cases of
noncompliance (37%), with age <56 yrs old demonstrating significant (P = 0.02)
association with persons who were noncompliant with the outpatient program.
Forty-three percent of those younger than 56 yrs were noncompliant with program,
yet no patient older than 56 yrs was noncompliant. Working status approached
significance (P = 0.07) with those patients out of work demonstrating a greater
likelihood of noncompliance. There were no correlations found between other
patient characteristics and the level of compliance with the program.
CONCLUSIONS: When considering opiates as a treatment option, pain clinics should
have a heightened suspicion for younger and unemployed patients. Although these
findings should be examined in larger studies, they suggest that nonmedical
factors play a substantial role regarding success in such a structured opiate pain program.

Langue : ANGLAIS