Changes in Perceptions of Narcotic Analgesic Treatment and Quality of Life in Chronic Back Pain Patients

Min-Wook Kim; Choong-Young Kim; Ji-Won Lee; Cheol-Hwan Kim; Ju-Sim Oh; Yong-Soo Choi

doi:10.4184/jkss.2017.24.2.65

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Kim, Kim, Lee, Kim, Oh, and Choi: Changes in Perceptions of Narcotic Analgesic Treatment and Quality of Life in Chronic Back Pain Patients

Original Article

Journal of Korean Spine Surg 2017;24(2):65-71.

Published online: 30 June 2017

DOI: https://doi.org/10.4184/jkss.2017.24.2.65

Changes in Perceptions of Narcotic Analgesic Treatment and Quality of Life in Chronic Back Pain Patients

Min-Wook Kim, M.D., Choong-Young Kim, M.D., Ji-Won Lee, M.D., Cheol-Hwan Kim, M.D., Ju-Sim Oh, R.N., Yong-Soo Choi, M.D.

Department of Orthopaedic Surgery, Kwangju Christian Hospital, Gwangju, Korea

Corresponding author: Choong-Young Kim, M.D. ORCID ID: 0000-0002-0693-3130 (Yong-Soo Choi, M.D.) Department of Orthopaedic Surgery, Kwangju Christian Hospital, 37, Yangrimro, Nam-gu, Gwangju, Korea TEL: +82-62-650-5060, FAX: +82-62-650-5066 E-mail: bakter@daum.net

Received 27 December 20165 January 2017 Accepted 12 April 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study design

Prospective study.

Objectives

This study was conducted to investigate changes in perceptions of treatment using narcotic analgesics and quality of life in chronic back pain patients.

Summary of Literature Review

Negative perceptions of narcotic analgesics as pain killers have been established as factors affecting compliance and adherence.

Materials and Methods

A total of 140 patients who had chronic back pain for over 3 months were examined using clinical scales such as the Korean version of the Oswestry Disability Index (KODI), the Short Form-12 (SF-12), and a visual analog scale (VAS). The survey regarding narcotic analgesics classified patients as having positive perceptions if they reported absolutely not wanting to use them or being unlikely to use them at the primary interview and after 4 weeks of treatment.

Results

Ninety-four patients (68%) reported negative perceptions of narcotic analgesics at the primary interview. Sixty-one of those patients (64%) changed their perceptions, reporting positive perceptions after 4 weeks of treatment, as indicated by the ODI (p=0.01), SF-12 (p=0.01), and VAS (p=0.01) scores. A change from positive to negative perceptions after 4 weeks of treatment was observed in 13 patients (28%) who experienced adverse effects of narcotics treatment (p=0.01). Among the 33 patients (23%) whose negative perceptions did not change, dissatisfaction with previous treatment was found to be a contributing factor in 22 (66%).

Conclusions

Clinical improvements after treatment using narcotic analgesics in chronic back pain patients resulted in a significant positive impact on perceptions about narcotic analgesics. Narcotic analgesics could be an alternative treatment choice in chronic back pain patients because of improvements in their quality of life.

Keywords: Lumbar, Chronic pain, Narcotic analgesics

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Fig. 1.

Changes in perceptions of narcotic analgesics between the pri-mary interview and after 4 weeks of treatment. There were 94 patients (68%) with negative perceptions of narcotic analgesics at the primary, premedication interview. Sixty-one patients (64%) reported a change from a negative perception to a positive perception after 4 weeks of treatment. P, positive perception; N, negative perception. The light gray portion of the bar graph indicates positive perceptions at the primary interview. The dark gray portion of the bar graph indicates negative perceptions at the primary interview.

Table 1.

Demographic data

Value	Number(N)	Ratio
Sex
Male	61	43.6%
Female	79	56.4%
Age
M± SD	65.3 ± 12.6
<59	41	29.2%
60-69	38	27.1%
70-79	51	36.4%
80-89	10	7.0%
Spouse
Yes^∗	95	67.9%
No^†	45	32.1%
Religion
Yes	89	63.6%
No	51	36.4%
Occupation
Yes	84	60.0%
No	56	40.0%
Smoking
Yes	49	35.0%
No	91	65.0%
Alcohol
Yes	52	37.1%
No	88	62.9%
Exercise
Yes	69	49.2%
No	71	50.8%

^∗ Yes: Yes means that they got married, and have Religion, Occupation and take smoking, alcohol and, doing exercise

^† No: No means that they are alone and have not religion, occupation and do not taking smoking, alcohol and didn't exercise.

Table 2.

Clinical improvement after taking narcotic analgesics

Value^∗	Premedication	Post-medication	p-value^†
Pain (VAS^‡)	7.8±0.77	3.4±1.68	0.01
ODI^§	69.1±14.16	39.2±16.40	0.01
SF-12^\|\|
PCS^¶	30.5±4.90	36.8±6.77	0.01
MCS^∗∗	28.8±5.62	44.3±7.67	0.01

^∗ Values are presented as mean±standard deviation

^† p-values of <0.05 were considered statistically significant.

^‡ VAS: visual analogue scale

^§ ODI: Oswestry Disability Index

^|| SF-12: Short form-12

^¶ PCS: Physiacal Component Score

^∗∗ MCS: Mental Component Score.

Table 3.

Comparisons of clinical characteristics according to perception of narcotic analgesics

Value^∗	Precognition		P^†	Postcognition		P
Value^∗	Negative	Positive	P^†	Negative	Positive	P
Sex			<0.05			0.72
Male	35	26		21	40
Female	59	20		25	54
Age			0.62			0.50
M± SD	65.71	64.58		64.32	65.84
Sleep disturbance			<0.05			0.83
Yes	70	26		31	65
No	24	20		15	29
Satisfaction			0.62			0.01
Yes	57	25		17	65
No	37	21		19	39
Side effect						0.01
Yes	-			26	10
No	-			20	84
VAS^‡ Change	4.4±1.7	4.1±1.7	0.38	3.6±1.9	4.7±1.4	0.01
ODI^§ Change	31.1±15.2	27.3±14.2	0.15	24.8±13.2	32.3±15.3	0.01
PCS^\|\| Change	−6.7±6.4	−5.3±5.07	0.20	−5.0±6.0	−6.9±6.0	0.07
MCS^¶ Change	−15.5±9.3	−15.4±8.4	0.92	−11.9±8.4	−17.2±8.8	0.01

^∗ Values are presented as mean±standard deviation

^† p-values of <0.05 were considered statistically significant

^‡ VAS: visual analogue scale

^§ ODI: Os-westry Disability Index

^|| PCS: Physiacal Component Score

^¶ MCS: Mental Component Score.

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