Early chronic pain risk identification can help cut opioid use. A Duke University Medical Center study in NEJM Catalyst found that two simple questions pick out the patients most likely to develop chronic pain. Those patients can then get early, personal care that leads to better results and less opioid use.
Summary: A study by Duke University Medical Center shows it is not hard to spot patients early who are at higher risk of chronic pain. A couple of questions can do it with good accuracy. That lets high-risk patients get early, personal care, which leads to better results.
The new study, published in NEJM Catalyst, shows that simple methods can spot chronic pain risk early. That helps patients get personal care, which leads to less opioid use.
Researchers have seen that not everyone is prone to chronic pain. In fact, only a small number of people who have surgery or a physical injury go on to develop it.
Studies suggest about 10% of people are prone to chronic pain. In these people, pain can easily become long-term. It can set off other problems, like mental health and behavior issues. So early spotting is the key to cutting the burden of chronic pain. Researchers at the Duke University Medical Center found that spotting high-risk people is not hard. Simple tools can do it.
Spotting these patients can help lower the risk of pain becoming chronic. It may also help lower the risk of problems like opioid overuse and abuse.
To do this, researchers made a simple test with just two questions. These two questions were enough to spot chronic pain risk in most patients. Unlike older methods, they aim to find people at risk so action can be taken early. That can help prevent chronic pain. Even if it does happen, these patients may get better care with higher cure rates.
The two questions given to the patients were:
- Have you ever felt your pain is terrible, and it’s never going to get any better? (Y/N)
- Have you ever used an illegal drug or prescription medication for non-medical reasons? (Y/N)
The researchers ran this survey on 13,500 patients. Of them, 12% said yes to both questions. These people were placed in the higher-risk group for chronic pain. This matches earlier findings that about one in ten patients are likely to develop chronic pain.
Researchers then split these patients into three groups: high, medium and low risk. They gave them personal care. That included referral to pain specialists, social support, and access to behavioral, physical and nutrition therapies.
Researchers say they built the support system on one guiding idea. People try to do their best to handle their problems. So a support network can make a big difference.
They found that of 432 high-risk patients, more than half, or 51%, cut their morphine dose within a month. By six months, 239 patients had cut their dependence on opioids.
Researchers say early spotting of chronic pain risk is the key to safe, effective, personal care. The study also shows that finding people at risk of chronic pain is not hard. So health care must take a proactive approach and give early, personal care to high-risk patients.
Frequently asked questions
Who is at risk of developing chronic pain?
Not everyone is prone to chronic pain. Only a small number of people who have surgery or a physical injury go on to develop it. Studies suggest about 10% of people are prone to it. In those people, pain can easily become long-term and bring mental health and behavior problems with it.
What two questions screen for chronic pain risk?
Duke researchers asked two yes-or-no questions. First: have you ever felt your pain is terrible and never going to get better? Second: have you ever used an illegal drug or a prescription drug for non-medical reasons? Of 13,500 patients surveyed, 12% said yes to both. They were placed in the higher-risk group.
Can chronic pain be prevented?
Early spotting is the key. Finding high-risk patients early lets doctors act early, which can lower the chance of pain becoming chronic. Even when chronic pain does develop, patients found early can get better, more personal care. It may also lower the risk of opioid overuse and abuse.
How does early identification cut opioid use?
High-risk patients got personal care. That meant referral to pain specialists, social support, and access to behavioral, physical and nutrition therapies. Of 432 high-risk patients, 51% cut their morphine dose within a month. By six months, 239 patients had cut their dependence on opioids.
Source:
Gulur, P., Christie, N., Pope, A., Zambrano, D., Vorenkamp, K., & Nelli, A. (2024). Duke Health Integrated Pain and Wellness Program—A Proactive Population Health Model. NEJM Catalyst, 5(4), CAT.23.0308. https://doi.org/10.1056/CAT.23.0308
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