People with chronic pain and long-term opioid use seek multiple forms of treatment

Opioids are powerful painkillers used, among other things, to treat acute and severe pain. At the same time, opioids are highly addictive, which is why great caution is recommended when using opioid treatment for long-term pain.

Nevertheless, some people with chronic pain use opioids over an extended period.

A new study from the National Institute of Public Health at the University of Southern Denmark has examined how people with chronic pain receiving long-term opioid treatment seek help and treatment.

The study shows that people with chronic pain, particularly those who use opioids over a longer period, have extensive use of both general practice and other treatment services. This is particularly the case for consultations with a general practitioner and visits to a physiotherapist.

“For example, 27 per cent of people with chronic pain and long-term opioid use had seen a physiotherapist within the past year, compared with 19 per cent among people with chronic pain without long-term opioid use,” explains PhD student Hannah Ahrensberg, one of the researchers behind the study.

Use of GPs and physiotherapists is even higher among people who also use complementary and alternative treatment, such as massage, acupuncture and reflexology.

“People with chronic pain who use both opioids and complementary and alternative treatment had an average of 29 consultations with a GP over the past year. By comparison, people with chronic pain without long-term opioid use, but who used complementary and alternative treatment, had an average of 15 consultations,” says Hannah Ahrensberg.

The study has just been published in the scientific journal BMC Complementary Medicine and Therapies. It is based on data from the Danish National Health and Morbidity Surveys from 2000 to 2021, linked to several national health registers.

The proportion of people with chronic pain is increasing

The study also shows that the proportion of people with chronic pain increased from 19 per cent in 2000 to 26 per cent in 2021. At the same time, the proportion of people with both chronic pain and long-term opioid use increased from 1.8 per cent in 2000 to 3.0 per cent in 2017, before falling to 2.4 per cent in 2021.

The decline in long-term opioid use can be viewed in the context of several years of efforts to reduce inappropriate opioid use. This is partly due to the risk of dependence associated with long-term treatment.

The Danish Health Authority currently recommends that opioids are primarily used for acute pain, cancer-related pain and pain at the end of life, and that opioid treatment should be used cautiously.

Often have complex treatment needs

The study cannot show why people with chronic pain who use opioids have more contact with the healthcare system. However, this may be related to the fact that people with chronic pain often have long-term and multifaceted needs for treatment and support.

This is according to senior researcher Nanna Gram Ahlmark, who contributed to the study.

“People with chronic pain often have complex and ongoing treatment needs. The extensive use of general practice, physiotherapy and complementary and alternative treatments may indicate that chronic pain is often not adequately addressed through a single form of treatment, even when opioids are part of the treatment,” she says.

She believes the findings highlight a need to look more closely at the overall course of treatment.

“A better understanding of patients’ treatment patterns may help develop more meaningful and coherent interventions that address the complex needs of people living with chronic pain,” says Nanna Gram Ahlmark.

In the study, chronic pain is self-reported and defined as chronic non-cancer pain lasting more than six months. Long-term opioid use is defined as having received three or more opioid prescriptions within the past 12 months.

Contact: PhD student Hannah Ahrensberg, e-mail: hana@sdu.dk eller tlf.: 6550 7703, and senior researcher Nanna Gram Ahlmark, e-mail: naah@sdu.dk eller tlf.: 6550 7815,  National Institute of Public Health, University of Southern Denmark