Abstract
Chronic non-cancer pain (CNCP) is a worldwide, common complaint and has a major impact on the individual and community in terms of social, financial and health costs. To date, research has been limited in a number of areas, including the association of CNCP with suicidality, the nature of pharmaceutical opioid use in people living with CNCP, the prevalence of Borderline Personality Disorder (BPD) in people living with CNCP, and associations between suicidality (i.e. ideation, plans and attempts) and problematic opioid use (e.g. dependence) in this population.
This thesis aimed to address these gaps using two data sources: the 2007 Australian National Survey of Mental Health and Well-being, and data from a large, national community survey of people living with CNCP, the Pain and Opioids IN Treatment (POINT) study. The studies included in this thesis aimed to: 1) examine the association of CNCP with suicidality in the Australia population; 2) describe the formation of the POINT cohort to examine prescription opioid use in CNCP; 3) examine the characteristics of CNCP patients prescribed pharmaceutical opioids; 4) examine characteristics associated with pharmaceutical opioid dose and pharmaceutical opioid dependence in the POINT cohort; 5) determine the prevalence of suicidality and independent predictors of general and pain-specific risk factors to suicidality in the POINT cohort, and 6) explore BPD in the POINT cohort and associations with problematic pharmaceutical opioid use and suicidality.
There were a number of important findings from this thesis. Firstly, in the POINT cohort, a large proportion consumed opioids in the high range (over 90mg of oral morphine equivalents mg per day) high-range opioid consumption was associated with problematic opioid use. Secondly, suicidality was common in people living with CNCP, especially in people prescribed opioids for CNCP. Multivariable regressions suggested that an individual’s confidence in coping with their pain was the only independent factor that was predictive of past 12-month progression from ideation to suicide attempt. Finally, screening positively for BPD was high amongst this sample and was associated with pharmaceutical opioid dependence and suicidality.
Clinical and research implications are discussed in terms of the need for a multidisciplinary approach to CNCP and the need for appropriate screening for the use of pharmaceutical opioids in the treatment of CNCP.