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Comparisons of All-Cause Mortality for Chronic Benign Pain Patients Prescribed NSAIDs only, Opiates or Opiates and Adjuvants

Randolph, David Charles, M.D.

Abstract Details

2014, PhD, University of Cincinnati, Medicine: Epidemiology (Environmental Health).
Summary 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 historical 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 percent 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 percent CI, 1.15-2.59). Age, sex and the number of emergency room visits are significant predictors of ACM. SLO and SA opiates only groups have ACM RR of 1.57 (95 percent CI, 0.92-2.71) and 1.23 (95 percent 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.
Erin Haynes, Dr.P.H. (Committee Chair)
Jianfei Guo, Ph.D. (Committee Member)
Paul Succop, Ph.D. (Committee Member)
52 p.

Recommended Citations

Citations

  • Randolph, M.D., D. C. (2014). Comparisons of All-Cause Mortality for Chronic Benign Pain Patients Prescribed NSAIDs only, Opiates or Opiates and Adjuvants [Doctoral dissertation, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1406900022

    APA Style (7th edition)

  • Randolph, M.D., David. Comparisons of All-Cause Mortality for Chronic Benign Pain Patients Prescribed NSAIDs only, Opiates or Opiates and Adjuvants. 2014. University of Cincinnati, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1406900022.

    MLA Style (8th edition)

  • Randolph, M.D., David. "Comparisons of All-Cause Mortality for Chronic Benign Pain Patients Prescribed NSAIDs only, Opiates or Opiates and Adjuvants." Doctoral dissertation, University of Cincinnati, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1406900022

    Chicago Manual of Style (17th edition)