Opioid Use as a Predictor of Pain Outcomes in Iraq and Afghanistan Veterans with Chronic Pain: Analysis of a Randomized Controlled Trial.

Bushey MA, Wu J, Outcalt SD, Krebs EE, Ang D, Kline M, Yu Z, Bair MJ. Opioid Use as a Predictor of Pain Outcomes in Iraq and Afghanistan Veterans with Chronic Pain: Analysis of a Randomized Controlled Trial. Pain medicine (Malden, Mass.). 2021 Dec 11; 22(12):2964-2970.

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Abstract:

OBJECTIVE: Our objectives were to: 1) assess the relationship between self-reported opioid use and baseline demographics, clinical characteristics and pain outcomes; and 2) examine whether baseline opioid use moderated the intervention effect on outcomes at 9?months. DESIGN: We conducted a secondary analysis of data from the Evaluation of Stepped Care for Chronic Pain (ESCAPE) trial, which found stepped-care to be effective for chronic pain in military veterans. SETTING: A post-deployment clinic and five general medicine clinics at a Veteran Affairs Medical Center. SUBJECTS: In total 241 veterans with chronic musculoskeletal pain; 220 with complete data at 9?months. METHODS: Examination of baseline relationships and multivariable linear regression to examine baseline opioid use as a moderator of pain-related outcomes including Roland Morris Disability Questionnaire (RMDQ), Brief Pain Inventory (BPI) Interference scale, and Graded Chronic Pain Scale (GCPS) at 9?months. RESULTS: Veterans reporting baseline opioid use (n? = 80) had significantly worse RMDQ (16.0?±?4.9 vs. 13.4?±?4.2, P? < .0001), GCPS (68.7?±?12.0 vs. 65.0?±?14.4, P? = .049), BPI Interference (6.2?±?2.2 vs. 5.0?±?2.1, P? < .0001), and depression (PHQ-9 12.5?±?6.2 vs. 10.6?±?5.7, P? = .016) compared to veterans not reporting baseline opioid use. Using multivariable modeling we found that baseline opioid use moderated the intervention effect on pain-related disability (RMDQ) at 9?months (interaction Beta = -3.88, P? = .0064) but not pain intensity or interference. CONCLUSIONS: In a stepped-care trial for pain, patients reporting baseline opioid use had greater improvement in pain disability at 9?months compared to patients not reporting opioid use.