Effect of chronic opioid therapy on actual driving performance in non-cancer pain patients
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Chronic non-cancer pain (CNCP) is a major health problem. Patients are increasingly treated with chronic opioid therapy (COT). Several laboratory studies have demonstrated that long-term use of opioids does not generally impair driving related skills. But there is still a lack of studies investigating on-the-road driving performance in actual traffic.
The present study assessed the impact of COT on road-tracking and car-following performance in CNCP patients.
Twenty CNCP patients, long-term treated with stable doses of opioid analgesics, and 19 healthy controls conducted standardized on-the-road driving tests in normal traffic. Performance of controls with a blood alcohol concentration (BAC) of 0.5 g/L was used as a reference to define clinically relevant changes in driving performance.
Standard Deviation of Lateral Position (SDLP), a measure of road-tracking control, was 2.57 cm greater in CNCP patients than in sober controls. This difference failed to reach statistical significance in a superiority test. Equivalence testing indicated that the 95% CI around the mean SDLP change was equivalent to the SDLP change seen in controls with a BAC of 0.5 g/L and did not include zero. When corrected for age differences between groups the 95% CI widened to include both the alcohol reference criterion and zero. No difference was found in car-following performance.
Driving performance of CNCP patients did not significantly differ from that of controls due to large inter-individual variations. Hence in clinical practice determination of fitness to drive of CNCP patients who receive opioid treatments should be based on an individual assessment.
KeywordsChronic pain Opioids On-the-road driving test SDLP
This work was conducted as part of the Driving under the influence of Drugs, Alcohol and Medicines (DRUID) research consortium funded by European Union grant TREN-05-FP6TR-S07.61320-518404-DRUID. This paper reflects only the authors’ view. The European Community is not liable for any use that may be made of the information contained therein.
The Federal Highway Research Institute (BASt) was coordinator of DRUID. Maastricht University was one of the partners involved into this project. Dr. M.B. Schumacher and Dr. A. Knoche are full time employees of BASt. Both have nothing to disclose. Dr. S. Jongen and Prof. J.G. Ramaekers are full time employees of Maastricht University. They have nothing to disclose. Dr. E.F. Vuurman is a full time employee of Maastricht University, too. He has received grants/research support grants from GlaxoSmithKline, Transcept, Eisai, ZonMW, Nabi and Merck companies. Prof. F. Petzke is a fulltime employee of the University Medical Center Goettingen. In the last three years he was on an advisory board for Janssen Cilag and received honorarium for an invited lecture from Janssen Cilag. Prof M. Vollrath is a full time university professor and head of the Department of Traffic and Engineering Psychology, Technische Universitaet Braunschweig, Germany. He has nothing to disclose.
We would like to thank all participants for taking part in our study. Our special thanks go to Henk Browers, Anita van Oers and the staff of the pain outpatient department of University Hospital Cologne.
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