Comparisons of All-Cause Mortality for Chronic Benign Pain Patients Prescribed NSAIDs only, Opiates or Opiates and Adjuvants
Year: 2014
Type: article
Study design: Observational Study
Abstract: of Background Data: Trends of increasing mortality with prescription opiate use have been reported in multiple publications.In populations with CNMP, adjuvant medications are commonly combined with opiates to decrease symptoms and/or side effects.Studies evaluating ACM of these combinations have not been reported in a workers' compensation population Objective: To determine the relative risk and predictors of all-cause mortality (ACM) among workers' compensation patients prescribed opiates for chronic non-malignant pain (CNMP) alone and in combination with commonly utilized adjuvant medications compared to those taking NSAIDs only.Methods: A h i s t o r i c a l cohort study of workers' compensation population in Ohio from 01/01/2000 to 06/10/2011 was conducted.NSAIDs only patients (controls) are compared to cases who are prescribed short acting opiates only (SA), short and long acting opiates (SLO), short and long acting opiates and/or anxiolytic and/or sedative and/or hypnotic medication (SLO + ASH), and short and long acting opiates and/or any muscle relaxers and/or antidepressants (SLO + MR/AD).Outcome of interest is ACM.Relative risk and adjusted risk factors of ACM are presented for each medication group.Results: When comparing to NSAIDs only subjects, patients taking SLO + ASH have the highest RR for death, 3.22 (95% CI, 1.60-6.94).Age, sex, dose and duration on medications are not significant predictors of mortality.Patients who are prescribed SLO + MR/AD also have increased risks of mortality, RR 1.73 (95% CI, 1.15-2.59).Age, sex and the number of emergency room visits are significant predictors of ACM.iii SLO and SA opiates only groups have ACM RR of 1.57 (95% CI, 0.92-2.71)and 1.23 (95% CI, 0.89-1.69)respectively.Age and total medications prescribed are significant predictors of ACM in both of these groups.Conclusion: The use of any anxiolytic, sedative, and/or hypnotic medications with short and long acting opiates in combination poses a significant increased risk of ACM.A lesser, but still highly significant risk of death is noted when combining SLO and MR/AD medications.Health care providers should be aware of these risks to provide safe medical care for the injured workers.iv
Author: David Charles Randolph
Institution: University of Cincinnati
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2557742476