European Journal of Clinical Pharmacology

, Volume 72, Issue 8, pp 977–985 | Cite as

Persistent analgesic use and the association with chronic pain and other risk factors in the population—a longitudinal study from the Tromsø Study and the Norwegian Prescription Database

  • Per-Jostein Samuelsen
  • Kristian Svendsen
  • Tom Wilsgaard
  • Audun Stubhaug
  • Christopher Sivert Nielsen
  • Anne Elise Eggen
Pharmacoepidemiology and Prescription
First Online:
Received:
Accepted:

Abstract

Purpose

Analgesics are commonly used drugs. The long-term effectiveness is mostly unproven, while the risk of several serious adverse effects is well established. We aimed to estimate the prevalence and incidence of persistent analgesic use and the association with chronic pain and sociodemographic and comorbid risk factors.

Methods

The Tromsø Study is an epidemiological, prospective study of health and diseases. We linked the sixth wave (Tromsø 6, 2007–08, n = 12,981) with the Norwegian Prescription Database (NorPD, 2004–13). Persistent analgesic use was defined as the use of analgesics, i.e., either non-steroidal anti-inflammatory drugs, opioids or paracetamol, for ≥90 days with proportion-of-days-covered ≥40 %. The study design provided both cross-sectional and longitudinal data; a cohort of 11,905 persons was followed for 4.5 years.

Results

The prevalence of persistent analgesic use was 4 % in general and 10 % among those reporting chronic pain. The incidence rate of persistent analgesic use was 21 per 1000 person-years in general. Baseline chronic pain doubled the risk of incident persistent analgesic use (HR = 2.05, 95 % CI 1.80–2.33). The risk increased with increasing chronic pain severity, as measured by chronic pain duration, frequency, intensity, and number of body locations. Sociodemographic risk factors were older age, female sex, lower education, and most likely lower physical activity. Psychological distress was not a statistical significant risk factor.

Conclusions

This study showed a relatively low prevalence of persistent analgesic use and that the majority of persons reporting chronic pain do not use analgesics persistently.

Keywords

Analgesics Non-steroidal anti-inflammatory agents Acetaminophen Opioids Persistence Chronic pain Pharmacoepidemiology 
This is a preview of subscription content, log in to check access.

Notes

Acknowledgments

This study was funded by a grant from the Northern Norway Regional Health Authority (8709/SFP1092-13). We thank the participants of the Tromsø Study.

Authors’ contributions

PJS, KS, AS, CSN, and AEE planned the study. PJS conducted the analysis and wrote the draft and the final manuscript. KS, TW, CSN, and AEE aided in the analysis. All authors contributed in the interpretation of the results. All authors have read and approved the final manuscript.

Compliance with ethical standards

Competing interests

The authors declare that they have no competing interests.

Supplementary material

228_2016_2056_MOESM1_ESM.docx (232 kb)
ESM 1 (DOCX 231 kb)

References

  1. 1.
    Samuelsen PJ, Slørdal L, Mathisen UD, Eggen AE (2015) Analgesic use in a Norwegian general population: change over time and high-risk use—the Tromsø Study. BMC Pharmacol Toxicol 16(1):16. doi: 10.1186/s40360-015-0016-y CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Sarganas G, Buttery A, Zhuang W, Wolf I-K, Grams D, Rosario A, Scheidt-Nave C, Knopf H (2015) Prevalence, trends, patterns and associations of analgesic use in Germany. BMC Pharmacol Toxicol 16(1):28. doi: 10.1186/s40360-015-0028-7 CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Ruscitto A, Smith BH, Guthrie B (2015) Changes in opioid and other analgesic use 1995-2010: repeated cross-sectional analysis of dispensed prescribing for a large geographical population in Scotland. Eur J Pain 19(1):59–66. doi: 10.1002/ejp.520 CrossRefPubMedGoogle Scholar
  4. 4.
    Boudreau D, Von Korff M, Rutter CM, Saunders K, Ray GT, Sullivan MD, Campbell CI, Merrill JO, Silverberg MJ, Banta-Green C, Weisner C (2009) Trends in long-term opioid therapy for chronic non-cancer pain. Pharmacoepidemiol Drug Saf 18(12):1166–1175. doi: 10.1002/pds.1833 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Zhou Y, Boudreau DM, Freedman AN (2014) Trends in the use of aspirin and nonsteroidal anti-inflammatory drugs in the general U.S. population. Pharmacoepidemiol Drug Saf 23(1):43–50. doi: 10.1002/pds.3463 CrossRefPubMedGoogle Scholar
  6. 6.
    Chaparro LE, Furlan AD, Deshpande A, Mailis-Gagnon A, Atlas S, Turk DC (2014) Opioids compared with placebo or other treatments for chronic low back pain: an update of the Cochrane Review. Spine (Phila Pa 1976) 39(7):556–563. doi: 10.1097/brs.0000000000000249 CrossRefGoogle Scholar
  7. 7.
    Chou R, Turner JA, Devine EB, Hansen RN, Sullivan SD, Blazina I, Dana T, Bougatsos C, Deyo RA (2015) The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med 162(4):276–286. doi: 10.7326/M14-2559 CrossRefPubMedGoogle Scholar
  8. 8.
    Ennis ZN, Dideriksen D, Vaegter HB, Handberg G, Pottegard A (2016) Acetaminophen for chronic pain: a systematic review on efficacy. Basic Clin Pharmacol Toxicol 118(3):184–189. doi: 10.1111/bcpt.12527 CrossRefPubMedGoogle Scholar
  9. 9.
    Gøtzsche PC (2000) Non-steroidal anti-inflammatory drugs. BMJ 320(7241):1058–1061CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Annemans L (2011) Pharmacoeconomic impact of adverse events of long-term opioid treatment for the management of persistent pain. Clin Drug Investig 31(2):73–86. doi: 10.2165/11536290-000000000-00000 CrossRefPubMedGoogle Scholar
  11. 11.
    Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D (2006) Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain 10(4):287–333. doi: 10.1016/j.ejpain.2005.06.009 CrossRefPubMedGoogle Scholar
  12. 12.
    Rustoen T, Wahl AK, Hanestad BR, Lerdal A, Paul S, Miaskowski C (2004) Prevalence and characteristics of chronic pain in the general Norwegian population. Eur J Pain 8(6):555–565. doi: 10.1016/j.ejpain.2004.02.002 CrossRefPubMedGoogle Scholar
  13. 13.
    Landmark T, Romundstad P, Dale O, Borchgrevink PC, Kaasa S (2012) Estimating the prevalence of chronic pain: validation of recall against longitudinal reporting (the HUNT pain study). Pain 153(7):1368–1373. doi: 10.1016/j.pain.2012.02.004 CrossRefPubMedGoogle Scholar
  14. 14.
    Fredheim OM, Mahic M, Skurtveit S, Dale O, Romundstad P, Borchgrevink PC (2014) Chronic pain and use of opioids: a population-based pharmacoepidemiological study from the Norwegian Prescription Database and the Nord-Trondelag Health Study. Pain 155(7):1213–1221. doi: 10.1016/j.pain.2014.03.009 CrossRefPubMedGoogle Scholar
  15. 15.
    Svendsen K, Fredheim OM, Romundstad P, Borchgrevink PC, Skurtveit S (2014) Persistent opioid use and socio-economic factors: a population-based study in Norway. Acta Anaesthesiol Scand 58(4):437–445. doi: 10.1111/aas.12281 CrossRefPubMedGoogle Scholar
  16. 16.
    Svendsen K, Skurtveit S, Romundstad P, Borchgrevink PC, Fredheim OMS (2012) Differential patterns of opioid use: defining persistent opioid use in a prescription database. Eur J Pain 16(3):359–369. doi: 10.1002/j.1532-2149.2011.00018.x CrossRefPubMedGoogle Scholar
  17. 17.
    Von Korff M, Saunders K, Thomas Ray G, Boudreau D, Campbell C, Merrill J, Sullivan MD, Rutter CM, Silverberg MJ, Banta-Green C, Weisner C (2008) De facto long-term opioid therapy for noncancer pain. Clin J Pain 24(6):521–527. doi: 10.1097/AJP.0b013e318169d03b CrossRefPubMedGoogle Scholar
  18. 18.
    Helin-Salmivaara A, Klaukka T, Huupponen R (2003) Heavy users of non-steroidal anti-inflammatory drugs: a nationwide prescription database study in Finland. Eur J Clin Pharmacol 59(5–6):477–482. doi: 10.1007/s00228-003-0635-x CrossRefPubMedGoogle Scholar
  19. 19.
    Hargreave M, Andersen TV, Nielsen A, Munk C, Liaw KL, Kjaer SK (2010) Factors associated with a continuous regular analgesic use—a population-based study of more than 45, 000 Danish women and men 18-45 years of age. Pharmacoepidemiol Drug Saf 19(1):65–74. doi: 10.1002/pds.1864 CrossRefPubMedGoogle Scholar
  20. 20.
    Eggen AE, Mathiesen EB, Wilsgaard T, Jacobsen BK, Njølstad I (2013) The sixth survey of the Tromsø study (Tromsø 6) in 2007–08: collaborative research in the interface between clinical medicine and epidemiology: study objectives, design, data collection procedures, and attendance in a multipurpose population-based health survey. Scand J Public Health 41(1):65–80. doi: 10.1177/1403494812469851 CrossRefPubMedGoogle Scholar
  21. 21.
    Jacobsen BK, Eggen AE, Mathiesen EB, Wilsgaard T, Njolstad I (2012) Cohort profile: the Tromso study. Int J Epidemiol 41(4):961–967. doi: 10.1093/ije/dyr049 CrossRefPubMedGoogle Scholar
  22. 22.
    Furu K (2008) Establishment of the nationwide Norwegian Prescription Database (NorPD)—new opportunities for research in pharmacoepidemiology in Norway. Norsk Epidemiol 18(2):129–136Google Scholar
  23. 23.
    Poluzzi E, Motola D, Silvani C, De Ponti F, Vaccheri A, Montanaro N (2004) Prescriptions of antidepressants in primary care in Italy: pattern of use after admission of selective serotonin reuptake inhibitors for reimbursement. Eur J Clin Pharmacol 59(11):825–831. doi: 10.1007/s00228-003-0692-1 CrossRefPubMedGoogle Scholar
  24. 24.
    Poluzzi E, Piccinni C, Sangiorgi E, Clo M, Tarricone I, Menchetti M, De Ponti F (2013) Trend in SSRI-SNRI antidepressants prescription over a 6-year period and predictors of poor adherence. Eur J Clin Pharmacol 69(12):2095–2101. doi: 10.1007/s00228-013-1567-8 CrossRefPubMedGoogle Scholar
  25. 25.
    Caetano PA, Lam JMC, Morgan SG (2006) Toward a standard definition and measurement of persistence with drug therapy: examples from research on statin and antihypertensive utilization. Clin Ther 28(9):1411–1424. doi: 10.1016/j.clinthera.2006.09.021 CrossRefPubMedGoogle Scholar
  26. 26.
    Strand BH, Dalgard OS, Tambs K, Rognerud M (2003) Measuring the mental health status of the Norwegian population: a comparison of the instruments SCL-25, SCL-10, SCL-5 and MHI-5 (SF-36). Nord J Psych 57(2):113–118. doi: 10.1080/08039480310000932 CrossRefGoogle Scholar
  27. 27.
    Toblin RL, Mack KA, Perveen G, Paulozzi LJ (2011) A population-based survey of chronic pain and its treatment with prescription drugs. Pain 152(6):1249–1255. doi: 10.1016/j.pain.2010.12.036 CrossRefPubMedGoogle Scholar
  28. 28.
    Moore A, Derry S, Eccleston C, Kalso E (2013) Expect analgesic failure; pursue analgesic success. BMJ 346:f2690. doi: 10.1136/bmj.f2690 CrossRefPubMedGoogle Scholar
  29. 29.
    Eriksen J, Jensen MK, Sjogren P, Ekholm O, Rasmussen NK (2003) Epidemiology of chronic non-malignant pain in Denmark. Pain 106(3):221–228. doi: 10.1016/s0304-3959(03)00225-2 CrossRefPubMedGoogle Scholar
  30. 30.
    Eggen AE (1993) The Tromso study: frequency and predicting factors of analgesic drug use in a free-living population (12-56 years). J Clin Epidemiol 46(11):1297–1304. doi: 10.1016/0895-4356(93)90098-L CrossRefPubMedGoogle Scholar
  31. 31.
    Landmark T, Romundstad PR, Borchgrevink PC, Kaasa S, Dale O (2013) Longitudinal associations between exercise and pain in the general population—the HUNT pain study. PLoS One 8(6):e65279. doi: 10.1371/journal.pone.0065279 CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Eriksen J, Sjogren P, Bruera E, Ekholm O, Rasmussen NK (2006) Critical issues on opioids in chronic non-cancer pain: an epidemiological study. Pain 125(1–2):172–179. doi: 10.1016/j.pain.2006.06.009 CrossRefPubMedGoogle Scholar
  33. 33.
    Hotopf M, Mayou R, Wadsworth M, Wessely S (1998) Temporal relationships between physical symptoms and psychiatric disorder—results from a national birth cohort. Br J Psychiatry 173(3):255–261. doi: 10.1192/bjp.173.3.255 CrossRefPubMedGoogle Scholar
  34. 34.
    McBeth J, Macfarlane GJ, Silman AJ (2002) Does chronic pain predict future psychological distress? Pain 96(3):239–245. doi: 10.1016/s0304-3959(01)00452-3 CrossRefPubMedGoogle Scholar
  35. 35.
    Nitter AK, Pripp AH, Forseth KØ (2012) Are sleep problems and non-specific health complaints risk factors for chronic pain? A prospective population-based study with 17 year follow-up. Scand J Pain 3(4):210–217. doi: 10.1016/j.sjpain.2012.04.001 CrossRefGoogle Scholar
  36. 36.
    Tanskanen A, Taipale H, Koponen M, Tolppanen A-M, Hartikainen S, Ahonen R, Tiihonen J (2014) From prescriptions to drug use periods—things to notice. BMC Res Notes 7(1):796. doi: 10.1186/1756-0500-7-796 CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Svendsen K, Borchgrevink P, Fredheim O, Hamunen K, Mellbye A, Dale O (2011) Choosing the unit of measurement counts: the use of oral morphine equivalents in studies of opioid consumption is a useful addition to defined daily doses. Palliat Med 25(7):725–732. doi: 10.1177/0269216311398300 CrossRefPubMedGoogle Scholar
  38. 38.
    Galea S, Tracy M (2007) Participation rates in epidemiologic studies. Ann Epidemiol 17(9):643–653. doi: 10.1016/j.annepidem.2007.03.013 CrossRefPubMedGoogle Scholar
  39. 39.
    Eggen AE (1996) The use of controlled analgesics in a general population (15-59 years)—the influence of age, gender, morbidity, lifestyle and sociodemographic factors. Pharmacoepidemiol Drug Saf 5(2):101–111. doi: 10.1002/(sici)1099-1557(199603)5:2<101::aid-pds202>3.0.co;2-k CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Per-Jostein Samuelsen
    • 1
    • 2
  • Kristian Svendsen
    • 3
  • Tom Wilsgaard
    • 2
  • Audun Stubhaug
    • 4
    • 5
  • Christopher Sivert Nielsen
    • 4
    • 6
  • Anne Elise Eggen
    • 2
  1. 1.Regional Medicines Information and Pharmacovigilance Center (RELIS)University Hospital of North NorwayTromsøNorway
  2. 2.Department of Community MedicineUiT—The Arctic University of NorwayTromsøNorway
  3. 3.Tromsø Hospital PharmacyTromsøNorway
  4. 4.Department of Pain Management and Research, Division of Emergencies and Intensive CareOslo University HospitalOsloNorway
  5. 5.Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway
  6. 6.Division of Mental HealthNorwegian Institute of Public HealthOsloNorway

Personalised recommendations