Objectives:

The Addiction Severity Index (ASI) is a standardized interview used to assess problems associated with substance use. Although widely used, the time required for the interview remains an obstacle to its acceptance in many clinical settings. We examined if a self-administered questionnaire based on the composite score (CS) items, the ASI Self-Report form (ASI-SR), offers a reliable alternative to the ASI in assessing current substance use and related problems.

Methods:

Participants were 59 treatment seeking individuals entering outpatient programs at the Addiction Psychiatric Clinic at Uppsala University Hospital who were assessed with Swedish versions of the ASI and ASI-SR. Agreement between the ASI interview's CS and ASI-SR's CS was evaluated on the individual basis by intraclass correlation analysis (ICC) and on group level with the Wilcoxon signed rank test. Reliability and internal consistency were evaluated using Cronbach's alpha.

Results:

For 6 out of 7 CS domains, the ICC for the ASI interview and ASI-SR were good to excellent. Internal consistency was acceptable for 6 out of 7 CS domains on the ASI interview and for 5 out of 7 CS domains on the ASI-SR.

Conclusions:

The present study suggests that the ASI-SR is a reliable alternative to the ASI interview for assessing current patient functioning and evaluation of problems related to alcohol and drug use.

AbstractObjectives: This study aimed to investigate the acceptability of study participation and feasibility of i) recruitment, ii) data collection and iii) outcome measures of a prospective cohort of patients with chronic-non-cancer pain (CNCP), the U-PAIN cohort. The overall aim of the cohort study is to identify predictors for risks and benefits associated with chronic opioid therapy (COT). 

Design: Internal feasibility study including baseline data and retention rate of the one-year follow-up. 

Setting: A secondary and tertiary care Pain Center at a university hospital in Sweden with a national catchment area.

Participants: Sixty-four patients with CNCP, > 18 years, literate in Swedish, referred to consultation and/or treatment at the Pain Centre. 

Outcome measures: Acceptability of study participation was measured with a study-specific 10-item Likert scale. Feasibility of recruitment was assessed by recording participation rates at baseline and number of individuals completing the one-year follow-up. Feasibility of data collection and outcome measures in the cohort study were examined by completions rates of study procedures, sample scores, and agreement between self-reported data and data retrieved from medical records on opioid use. 

Results: Study participants reported an overall acceptable satisfaction with Participation retention rate at the one-year follow-up was 82%. The completion rates for the different data collection methods ranged from 83% to 95%. Agreement between self-reported opioid use and prescribed dose was high (к= .91). Eleven individuals met the criteria for any OUD, and three individuals met the criteria for moderate- severe OUD. Agreement between OUD according to DSM-5, and clinical ICD-10 diagnoses for opioid dependence measured with prevalence-adjusted and bias-adjusted kappa (PABAK) was high (κ= .90). The participants reported poor work ability.  

Conclusions: This feasibility study has helped to highlight and improve methods for recruitment, data collection and use of outcome measures for the U-PAIN cohort. A majority of participants reported an overall satisfaction with study participation, and the methods used for data collection were found feasible. .Low participation rate, and high refusal rates at baseline is a challenge that needs to be further addressed.

Background: The use of opioids to relieve chronic pain has increased during the last decades, but experiences of chronic opioid therapy (COT) (> 90 days) point at risks and loss of beneficial effects. Still, some patients report benefits from opioid medication, such as being able to stay at work. Guidelines for opioid use in chronic pain do not consider the individual experience of COT, including benefits and risks, making the first person perspective an important scientific component to explore. The aim of this study was to investigate the lived experience of managing chronic pain with opioids in a sample who have severe chronic pain but are able to manage their pain sufficiently to remain at work.

Methods: We used a qualitative research design: interpretative phenomenological analysis. Ten individuals with chronic pain and opioid therapy were purposively sampled in Swedish tertiary care.

Results: Three super-ordinate themes emerged from the analyses: Without opioids, the pain becomes the boss; Opioids as a salvation and a curse, and Acknowledgement of the pain and acceptance of opioid therapy enables transition to a novel self. The participants used opioids to regain control over their pain, thus reclaiming their wanted life and self, and sense of control over one's life-world. Using opioids to manage pain was not unproblematic and some of the participants had experienced a downward spiral of escalating pain and uncontrollable opioid use, and stigmatisation.

Conclusions: All participants emphasised the importance of control, regarding both pain and opioid use. To accomplish this, trust between participants and health care providers was essential for satisfactory treatment. Regardless of the potential sociocultural benefits of staying at work, participants had experiences of balancing positive and negative effects of opioid therapy, similar to what previous qualitative research has found. Measurable improvement of function and quality of life, may justify the long-term use of opioids in some cases. However, monitoring of adverse events should be mandatory. This requires close cooperation and a trusting relationship between the patients and their health care provider.

Abstract

Objective: To explore prescribers’ understanding of what makes initial prescription of opioids become long-term-opioid therapy (opioids >90 days).

Design: Qualitative study, using phenomenography for data analysis.

Methods: Semi-structured interviews conducted by one researcher were used for data collection. Participants were recruited consecutively until categorical saturation was reached. The transcripts were analyzed and categorized by two researchers. A third researcher checked for consistency between the data and the categories. An outcome space was constructed representing the logical relationship between the categories.

Setting: Primary, secondary and tertiary care in Sweden.

Subjects: Fifteen attending physicians working within the fields of general practice, rehab medicine, orthopedic surgery, neurosurgery, or obstetrics and gynecology.

Results: The analysis identified six categories: The addictive opioid, The deserving patient, The ignorant prescriber, The lost patient, The compassionate prescriber, and The exposed prescriber. The differences in conceptions among the categories were clarified through three main contributors related to opioid therapy: prescriber’s characteristics, patient’s characteristics, and the healthcare organization.

Conclusion: Opioids were understood as being addictive with long-term use promoting a downward spiral of tolerance and withdrawal driving the pain, leading to continued prescription. Long-term opioid therapy could be justified for patients who improved in function, and who were perceived as trustworthy. Inadequate follow-up of patients, poor training in pain management and addiction medicine, personal attitudes and beliefs about opioids, a perceived professional obligation to treat patients with pain, and lack of collegial support, were factors understood to promote clinically unindicated long-term opioid therapy.