Presented at the 2013 AAPM Annual Meeting « Back

Impact of Prescribed Opioids on Biopsychosocial-Spiritual Function in Sickle Cell Anemia Patients: A Multi-phase, Mixed Methods Study

Abdulkhaliq J. Alsalman, MS, alsalmanaj@vcu.edu¹, Jennifer K. Li Wong¹, Wally R. Smith, MD¹, (1) Virginia Commonwealth University, Richmond, Virginia

Introduction: The rapid growth in opioid therapy for non-cancer pain has occurred without an adequate appreciation of its consequences. Therefore, management of non-cancer pain, specifically deciding when and how to use opioids, remains a challenge to physicians and patients. Few have reported comprehensively and simultaneously all the negative and positive outcomes of prescribed opioids in groups of patients using a biopsychosocial-spiritual perspective. We therefore sought to explore the effects of prescribed opioids on biopsychosocial-spiritual function in sickle cell disease (SCD). As part of a multiphase, mixed-method study, we conducted wide-ranging quantitative and semi-structured, qualitative interviews of African-American adults with SCD. The final sample consisted of 21 participants (11 men), average age 36 years, from various demographic and socioeconomic statuses. We used a grounded theory approach to analyze the data. Qualitative thematic analysis uncovered several patterns of opioid-taking behavior and several related biopsychosocial phenomena. Participants also reported a variety of effects of taking opioids on their life and biopsychosocial-spiritual function. First, we classified effects into one of five domains: biological, psychological, social, spiritual, and miscellaneous life effects. Second, within each domain, we classified effects as positive, negative, or divergent. Uniformly negative effects included: social withdrawal and feelings of guilt. Uniformly positive effects included: independence from pain and avoidance of pity or sympathy. Divergent effects included sometimes improved and sometimes worsened: relationships, productivity in school or work, mood, social and spiritual commitments, outlook, and demeanor. In all types of effects, biological effects appeared to be mediators of more indirect effects which led to alterations in subsequent opioid taking behavior. In conclusion, we found divergent effects of prescribed opioids in various domains among SCD patients, which likely modulate subsequent opioid taking behavior. Together, these uncovered phenomena raise new hypotheses that may challenge current models of opioid-taking behavior and opioid effects, which need to be rigorously, tested in future research. Quantification of these phenomena would prove useful when prescribers are deciding when and how to use opioids for non-cancer pain.

Funding: None.