Person:

Jamison, Robert

Background: Chronic pain with neuropathic characteristics is considered to be an international health problem. However, surveys on the actual incidence of neuropathic pain have not been conducted in many Middle East countries, including Kuwait. The aim of this study was to examine the incidence of pain and medical comorbidities among a random sample of patients treated at a large medical center in Kuwait. Methods: A list of 1,000 patients was created from the hospital medical record system, and a telephone survey was conducted on 759 patients who responded to the phone call, of which 67.2% (N=510) participated. Those who stated that they had pain every day for the past 3 months were invited to answer additional questions about their pain. Results: Fifty-six percentage of those surveyed (N=283) reported experiencing chronic pain. Total average age was 49.2 years (SD=14.5), 45.5% were female, and 70.5% were Kuwaiti nationals. Most (74.3%) reported having diabetes and one-third (32.2%) showed evidence of neuropathic pain characteristics (mean DN4=2.8, SD=1.7). Other comorbid medical conditions were prevalent (48.4% hypertension, 30.4% arthritis, 22.6% heart disease, and 20.4% asthma) with an average of 2.3 (SD=1.3) medical problems per person. Those with pain tended to be older, female, unemployed, and overweight (p<0.01). The pain was mostly located in the lower extremities and those with neuropathic pain tended to report a higher intensity of pain and a higher frequency of seeking treatment for their pain in a clinic or hospital (p<0.05). Most relied on over-the-counter medications for their pain (38.1%). Very few were taking prescription medication for their pain. Conclusion: This survey suggests that chronic pain is more prevalent in a medical population in Kuwait than previously anticipated. Health care services and behavioral interventions to improve lifestyle changes in Kuwait and other Arab countries are needed to positively impact pain and reduce other comorbidities.

Abstract Background: There is increasing concern among primary care practitioners about the use of opioids for chronic pain, including their adverse effects, but little attention has been given to how reports of side effects from prescription medication can contribute to outcomes among patients with chronic pain. The aim of this study was to investigate the impact of frequently reported side effects on mood, disability, and opioid misuse in patients with chronic pain prescribed opioids within primary care. Methods: Two hundred (N = 200) patients with chronic pain taking opioids for pain were recruited into the study. All patients completed baseline measures and a monthly side effects checklist once a month for 6 months. Patients were divided evenly based on a median split of the number of endorsed side effects over 6 months. The subjects repeated the baseline measures at the end of the study period. Results: Over time, reports of medication side effects tended to decrease, but differences in frequency of reported side effects from baseline to follow-up (6-month time) were not significant, and the order of the frequency of the reported side effects remained similar. Patients who reported significant medication-related adverse effects reported significantly greater activity interference, negative affect, and catastrophizing compared with those with fewer side effects (P < 0.01). In addition, those patients with pain who reported more side effects showed significantly higher scores on opioid misuse risk (P < 0.001). Discussion: This study demonstrates the important role of monitoring medication-related side effects among patients with chronic pain who are prescribed opioid medication for pain within primary care.