Online citations, reference lists, and bibliographies.
Please confirm you are human
(Sign Up for free to never see this)
← Back to Search

What Factors Affect Physicians' Decisions To Prescribe Opioids For Chronic Noncancer Pain Patients?

D. Turk, A. Okifuji
Published 1997 · Medicine

Save to my Library
Download PDF
Analyze on Scholarcy
Share
OBJECTIVE To evaluate the contribution of pain severity, physical pathology, demographic factors, initiators of symptoms, affective distress, behavioral expressions of pain, and functional activity levels in physicians' decisions to prescribe opioid medication for chronic noncancer pain patients. DESIGN Patients were examined by a physician and physical therapist, interviewed by a psychologist, and asked to complete a medical history form and a set of self-report questionnaires. Patients who were prescribed opioids were compared with those who were not prescribed opioids on each of these. In addition, logistic regression analysis was performed to determine the best predictors of opioid prescriptions. SUBJECTS A total of 191 (96 female and 95 male) consecutive patients referred to a multidisciplinary pain treatment facility diagnosed with a variety of chronic pain syndromes. RESULTS Neither pain severity nor objective physical pathology influenced physicians' prescribing of opioids medication. Similarly, duration of pain and demographic factors had minimal impact on prescribing of opioids. Patients' behavioral manifestations of pain, distress, and suffering--pain behaviors--and reports of functional disability and distress did distinguish between patients prescribed opioid medications from those who did not. However, when all variables were entered into a logistic regression model, only observed pain behaviors showed a significant association with opioid prescriptions. CONCLUSIONS Physicians' practice in prescribing of opioids appears to be influenced most by patients' nonverbal communications of pain, distress, and suffering. Some of the factors not directly evaluated in this study that may also contribute to the decision to prescribe opioids for chronic noncancer pain patients are discussed.
This paper references
10.1177/014662167700100306
The CES-D Scale
L. S. Radloff (1977)
10.1046/j.1468-2982.1995.015003216.x
Psychosocial and Behavioral Characteristics in Chronic Headache Patients: Support for a Continuum and Dual-Diagnostic Approach
L. Scharff (1995)
10.1016/0003-9993(94)90082-5
The Pain Disability Index: factor structure and normative data.
J. Chibnall (1994)
10.1016/0304-3959(94)00167-D
Chronic pain and depression: role of perceived impact and perceived control in different age cohorts
D. Turk (1995)
10.1016/S0025-7125(16)31383-9
Narcotics in the elderly.
R. Kaiko (1982)
10.5555/URI:PII:0003999386902613
Epidemiologic comparison of persistent pain sufferers in a specialty pain clinic and in the community.
J. Crook (1986)
10.1016/0304-3959(85)90004-1
The West Haven-Yale Multidimensional Pain Inventory (WHYMPI)
R. Kerns (1985)
10.1001/JAMA.1979.03290460050020
Response of physicians to medical complaints in men and women.
K. J. Armitage (1979)
10.1016/0005-7967(94)90078-7
Detecting depression in chronic pain patients: adequacy of self-reports.
D. Turk (1994)
10.1016/0304-3959(88)90181-9
Differential utility of medical procedures in the assessment of chronic pain patients
T. Rudy (1988)
10.1016/S0304-3959(96)03182-X
Effects of type of symptom onset on psychological distress and disability in fibromyalgia syndrome patients
D. Turk (1996)
10.1097/00007632-198611000-00017
Comparative Validity of the Sickness Impact Profile and Shorter Scales for Functional Assessment in Low-Back Pain
R. Deyo (1986)
10.1016/0304-3959(94)90072-8
Physicians' attitudes and practices regarding the long-term prescribing of opioids for non-cancer pain
D. Turk (1994)
10.1177/01454455970213001
Evaluating the Role of Physical, Operant, Cognitive, and Affective Factors in the Pain Behaviors of Chronic Pain Patients
D. Turk (1997)
10.1037//1040-3590.5.1.117
A comparative analysis of measures used in the assessment of chronic pain patients
S. Mikail (1993)
10.1016/0304-3959(90)90047-H
The robustness of an empirically derived taxonomy of chronic pain patients
D. Turk (1990)
10.1007/BF02596214
Early diagnostic evaluation of low back pain
R. Deyo (1986)
The family and hypertension in family practice.
Romm Fj (1985)
10.1097/00002508-199203000-00003
Characteristics and response to treatment of posttraumatic temporomandibular disorder: a retrospective study.
G. Romanelli (1992)
10.1016/S0005-7894(05)80345-4
Observational assessment of chronic pain patient-spouse behavioral interactions
J. Romano (1991)
10.1016/0304-3959(89)90111-5
An epidemiological follow-up survey of persistent pain sufferers in a group family practice and specialty pain clinic
J. Crook (1989)
10.1016/0304-3959(93)90121-5
Evaluation of a chronic pain programme by referring physicians
A. Deathe (1993)
10.1016/0885-3924(92)90116-Y
Long-term oral opioid therapy in patients with chronic nonmalignant pain.
M. Zenz (1992)
10.1097/00007632-198403000-00013
Chronic Low‐Back Pain, Psychologic Distress, and Illness Behavior
G. Waddell (1984)
10.1016/0304-3959(92)90145-2
Efficacy of multidisciplinary pain treatment centers: a meta-analytic review
H. Flor (1992)
10.1097/00007632-199504150-00014
On the Utility of the West Haven‐Yale Multidimensional Pain Inventory
I. Bernstein (1995)
Pain, disability, and physical functioning in subgroups of patients with fibromyalgia.
D. Turk (1996)



This paper is referenced by
10.9790/0853-1508051223
Lumbar Degenerative Disc Disease: Clinical Presentation and Treatment Approaches
V. Gupta (2016)
10.3390/ijerph17176428
Opioid Pain Medication Prescription for Chronic Pain in Primary Care Centers: The Roles of Pain Acceptance, Pain Intensity, Depressive Symptoms, Pain Catastrophizing, Sex, and Age
C. Ramírez-Maestre (2020)
10.1002/14651858.CD004959.PUB3
Opioids for chronic low-back pain.
A. Deshpande (2007)
10.1016/J.JPAIN.2006.03.004
Factors associated with early opioid prescription among workers with low back injuries.
B. Stover (2006)
10.1007/978-1-4419-0029-6_7
Psychological Co-morbidities in Patients with Pain
B. Dorsten (2011)
10.2337/DIACARE.28.11.2673
Resistance to Insulin Therapy Among Patients and Providers Results of the cross-national Diabetes Attitudes, Wishes, and Needs (DAWN) study
M. Peyrot (2005)
10.1111/J.1526-4637.2006.00200.X
Do users of regularly prescribed opioids have higher rates of substance use problems than nonusers?
M. Edlund (2007)
10.1370/afm.1371
Depression and Prescription Opioid Misuse Among Chronic Opioid Therapy Recipients With No History of Substance Abuse
A. Grattan (2012)
10.22606/MCMR.2017.13002
Survey of Physician Perspective towards Management of Pain for Chronic Conditions in the Emergency Department
Daniel Sop (2017)
End-of-life care in general practice in the Netherlands
S. Borgsteede (2006)
10.1002/ajim.20655
Geographic variation in opioid prescribing for acute, work-related, low back pain and associated factors: a multilevel analysis.
B. Webster (2009)
10.1016/j.pain.2009.02.005
Pain assessment and treatment disparities: A virtual human technology investigation
A. Hirsh (2009)
10.1111/joim.13026
What proportion of patients with chronic noncancer pain are prescribed an opioid medicine? Systematic review and meta‐regression of observational studies
S. Mathieson (2020)
10.1093/BJA/87.1.133
Chronic opioid therapy for non-cancer pain.
B. Collett (2001)
10.1016/B978-84-8174-949-6.50022-8
Abordaje conductual-cognitivo en el tratamiento del dolor
D. Turk (2006)
10.1016/J.APMR.2007.03.004
Perceived and actual memory, concentration, and attention problems after whiplash-associated disorders (grades I and II): prevalence and predictors.
J. P. Robinson (2007)
Predictors Of Dental Opioid Analgesic Prescribing, Opioid Use And Dental Emergency Department Visits In The Mississippi Medicaid Population
C. Dibie (2018)
10.1515/sjpain-2019-0154
Self-reported traumatic etiology of pain and psychological function in tertiary care pain clinic patients: a collaborative health outcomes information registry (CHOIR) study
C. Taub (2020)
10.1002/14651858.CD004959.pub4
Opioids compared to placebo or other treatments for chronic low-back pain.
L. E. Chaparro (2013)
10.2337/DIACARE.29.04.06.DC05-0053
Resistance to insulin therapy among patients and providers: results of the cross-national Diabetes Attitudes, Wishes, and Needs (DAWN) study.
M. Peyrot (2005)
10.1159/000095363
Perspectives on pain and depression.
M. Clark (2004)
10.1097/BRS.0b013e3181809f07
Preoperative Narcotic Use as a Predictor of Clinical Outcome: Results Following Anterior Cervical Arthrodesis
J. T. Lawrence (2008)
10.1007/S11916-999-0061-6
Pain, psychologic status, and functional recovery among patients on daily opioids
R. Harden (1999)
10.5435/JAAOS-D-16-00750
Opioid Prescribing Practices of Orthopaedic Surgeons: Results of a National Survey
Eli Raneses (2019)
10.1097/SPC.0000000000000203
Opioids and chronic pain: using what we know to change what we do
C. Stannard (2016)
10.1007/978-1-61779-222-9_1
Pharmacogenetics in Clinical and Forensic Toxicology: Opioid Overdoses and Deaths
S. Jortani (2012)
10.1007/s10926-013-9417-1
Further Validation of a Measure of Injury-Related Injustice Perceptions to Identify Risk for Occupational Disability: A Prospective Study of Individuals with Whiplash Injury
Whitney Scott (2013)
10.1038/sj.sc.3101511
Types and effectiveness of treatments used by people with chronic pain associated with spinal cord injuries: influence of pain and psychosocial characteristics
E. Widerström-Noga (2003)
Quelles personnes sont susceptibles de développer une invalidité en raison de la douleuret comment intervenir en phase initiale? Les principes extraits des résultats de larecherche sur les facteurs prédisposants à l’invalidité
Manon Houle (2015)
10.3399/bjgp13X675403
GPs prescribing of strong opioid drugs for patients with chronic non-cancer pain: a qualitative study.
D. Seamark (2013)
10.1177/1461445619893796
Let’s talk about pain and opioids: Low pitch and creak in medical consultations
P. Torres (2020)
10.2106/JBJS.17.00149
Pain Relief After Operative Treatment of an Extremity Fracture: A Noninferiority Randomized Controlled Trial
G. Helmerhorst (2017)
See more
Semantic Scholar Logo Some data provided by SemanticScholar