Importance of Side Effects in Opioid Treatment A Trade-Off Analysis With Patients and Physicians

This study examined the relative impact of pain relief and opioid side effects on patients and physicians preferences for medication An Internet survey was completed by 618 patients (302 acute pain 316 chronic pain) and 325 physicians (83 primary care 80 pain specialists 41 oncologists 40 general surgeons 40 orthopedic surgeons 20 rheumatologists 21 neurologists) Respondents completed an Adaptive Conjoint Analysis (ACA) exercise in which they indicated their relative preference for 20 pairs of hypothetical opioid pain medications described by varying levels of pain relief and side effect incidence Almost all patients (96% of chronic 92% of acute) reported experiencing at least 1 side effect while on opioid medication but physician estimated incidence rates of most opioid side effects were much lower than those reported by patients Opioid side effects rather than pain relief explained the majority of variance for medication preference for both patients (74% for chronic 73% for acute) and treating physicians (73% for chronic 74% for acute) in this exercise Nausea and vomiting were major determinants of opioid medication preference with each explaining as much of the variance in preference as did pain relief (21% to 25%) Nausea and vomiting were the most important side effects based on the amount of pain relief that respondents were willing to give up for reducing the incidence of side effects The importance of side effects was confirmed in an open ended question where 51% of patients and 58% of physicians identified side effect reduction as an unmet need for pain medications Perspective This study provided insights into patient and physician preferences of the risk and benefit balance of opioid therapy This information could improve understanding of patient needs and facilitate the incorporation of patient preference into therapy choice (C) 2010 by the American Pain Society