Life Experiences of Individuals with chronic pain on Long Term Opioid Therapy

Purpose: Although long term opioid therapy has been shown to have efficacy in treating chronic pain, it has also been implicated to have suppressive hormonal and immune effects and the potential for hyperalgesia. Few long term analgesic studies have measured nonanalgesia outcomes, and findings are conflicting. Due to a risk of impaired psychosocial or physical function and the lack of associated research, the purpose of our project was to explore the personal daily life experience of individuals with chronic pain who have been on long term opioid therapy.

Method: Participants were recruited from a local rural pain clinic. Inclusion criteria were individuals who experienced chronic pain, were taking opioid drugs for pain management for over 6 months and had no major comorbidities. Participants were majority male (55%), average age 50 years (range 33-65) and predominantly Caucasian (84%). A mixed methods design was used including in-depth phenomenological interviews, a demographic/pain survey questionnaire and the SF-32 questionnaire that measures health. We report results of the qualitative data here. The interviews were conducted to determine the personal life experience of being on long term opioid therapy for individuals with chronic pain. Interviews were audio taped and transcribed verbatim. Transcriptions were analyzed using the Colaizzi method. Transcriptions were coded to formulate meaning categories and then organized into clusters of themes to describe the phenomenon. Five university faculty in Nursing and Psychology collaborated to collect and analyze the data.

Results: The major structure that emerged from the clustered themes was a continuum of chaos/discord to hanging on and persevering. The themes and sub-categories included the following. 1. Experiencing pain: Bearing pain; Coping with some relief; Minimizing impact; Accepting pain as part of life; Accepting what is real. 2. Living with effects: Memory loss; Impaired concentration; Fatigue; Not able to sleep; Depression; Worsening pain; Risk of overdose. 3. Searching for relief: Why am I taking; What can I do; Effectiveness of other therapies. 4. Ego integrity: Frustration; Normality; Self Support; Faith in self. 5. Difficult rules: Taking as prescribed; Drug screens; Managing bottles. 6. Bias & stigma: Judged as addicted; Rejected; Discrimination; No understanding. 7. Control: Respect-Caution; Breakthrough pain; Choices; Distraction; Sleep; Routines; 8. Loss: Minimizing impact on daily life; Productivity; Social isolation. 9. Fears: No relief; Invasive treatments; Loss of function; Death; Disability; Uncertainty. 10. Impact of support: Family; Health care providers.

Participants lived with daily chaos due to: Lack of complete relief of pain and living with constant pain; Nonanalgesic effects of opioids; Lack of psychosocial support; Difficult rules to follow to receive the opioids; Being judged by family, friends and healthcare workers; Loss of productivity and social interactions; and Fears of not getting any relief of pain, losing control, loss of function, disability and death. Participants expressed that they attempted to persevere andhang-on each day through: Developing a sense of self-support and faith in self; Redefining a new "normal;" Relying on supportive family when it was offered; Accepting what is "real" and pain as part of life; Daily planning to minimize impact on life; Seeking adjunctive therapies and using distraction techniques; Understanding why I am taking the drugs; Making choices; and Living with "some relief."

Conclusions: We discovered that participants experienced a level of chaos and altered functioning related to opioid therapy but were attempting to hang on to get through each day. Participants indicated that without opioids, they did not know how they could go on living with the pain. Health care providers need to consider the life experiences of these individuals and attempt to provide support and understanding, to become aware of their own potential bias, maintain a nonjudgmental approach in treating these patients, and consider that the use of opioid therapy for chronic pain is essential for these patients.