TREATMENT NON-ADHERENCE AND PSYCHOSOCIAL FACTORS IN PATIENTS WITH CHRONIC PAIN

Background: Chronic pain (CP) is a major healthcare problem. European Federation of International Association for the Study of Pain (IASP) defines CP as a daily pain that persists for 3 months, affecting different aspects of the patients’ life. CP is a subjective experience where both physical and psychological factors are involved. Non-adherence to prescribed pain medication is very common and may result in sub-optimal treatment outcome. This study aimed at investigating the association between treatment non- adherence and psychosocial factors. Methods: 118 consecutive outpatients (63.6 % female; mean age 57.1) with chronic pain, treated with analgesic medication, were recruited from the Pain Therapy Clinic - University of Bari General Hospital. We assessed treatment adherence (BMQ), levels of pain (Brief Pain Inventory - BPI), anxiety and depression (HADS), quality of life (SF-36), and cognitive functioning (Coloured Progressive Matrices - CPM). Results: Using the Necessity Concern Framework, we calculated a Non-Adherence Index (difference between BMQ Necessity Scale and BMQ Concern Scale). Non-adherent patients (lower quartile of Non-Adherence Index distribution) were significantly younger (53.95 ± 10.03, p<0.05), and showed beliefs about medicines as something harmful (BMQ Harm Scale, 14.21 ± 2.7, p<0.01). The mean of Non-Adherence Index correlated -0.24 (p<0.05) with Anxiety, -0.21 (p<0.05) with Depression, -0.21 (p<0.05) with Pain Severity, -0.35 (p<0.001) with BMQ Harm, -0.33 (p<0.001) with BMQ Overuse (beliefs about over- prescription of medication by doctors who place too much trust in them). Conclusions: In this sample, non-adherence to prescribed pain medication was characterized by demographic factors (younger age), anxiety, depression, pain intensity and perceived medicine harmfulness. The choice for pharmacological therapy should not only be based upon pain diagnosis but should also take the risks of non-adherence into account.