Anxiety, fear may promote reliance on chronic opioid analgesic therapy for pain

Among patients with chronic, noncancer pain (CNCP), fear avoidance beliefs and behaviour play an important role in refractory chronic opioid analgesic therapy (COAT) reliance, as shown in a study.

The retrospective study used electronic medical records (EMR) data from 109 patients with CNCP who participated in a multidisciplinary programme to cease COAT.

Pre-COAT cessation, oral morphine milligram equivalence (MME), and validated questionnaire responses assessing anxiety and fear-based beliefs and behaviour, as well as opioid misuse, were analysed and compared between those who successfully ceased COAT and those who did not.

Results revealed that patients who were not able to achieve COAT cessation reported significantly higher Fear Avoidance Behavior Questionnaire (FAB) scores.

On the other hand, there were no significant differences seen in incoming MME amounts, Current Opioid Misuse Measure (COMM), or Tampa Scale of Kinesiophobia (TSK) scores.

Pain Catastrophizing Scale (PCS) scores demonstrated a split pattern with unclear significance.

Chronic pain may partly be attributed to dysfunctional beliefs relating to pain itself and fear of pain. Such fear can lead to avoidance of activities that patients associate with the occurrence or exacerbation of pain, despite physical recovery from the associated condition. Avoidance of physical activities based on fear of movement, known as kinesophobia, can also contribute to a cycle of further fear and avoidance and ultimately lead to reduced muscle strength and flexibility, further delaying recovery from a painful condition. [J Anesth 2017;31:255-262]