An international study of analgesic dependence among people with pain in the general population.

BACKGROUND: Overuse of and dependence on analgesics (including opioids and other pain medications) are major international public health problems. OBJECTIVE: To identify influences on analgesic dependence among analgesic users in the general populations of different countries. METHODS: Online surveys of 1,283 people with pain in the UK, USA, Australia, Germany, Egypt and China/Macau/Hong Kong. RESULTS: Levels of analgesic overuse and dependence were highest in Egypt and lowest in China/Macau/Hong Kong. In every country except Egypt, frequency of pain and frequency of analgesic use were correlated with analgesic dependence, and scores on the Need subscale of the Pain Medication Attitudes Questionnaire (PMAQ) independently predicted analgesic dependence. In the UK, USA, Australia, and Germany, frequency of analgesic use mediated the effects of pain frequency or intensity, and Need scores mediated the effects of frequency of analgesic use. In Egypt, more recent pain, analgesic overuse, and the Emotion and Solicitude subscales of the Survey of Pain Attitudes independently predicted analgesic dependence. CONCLUSIONS: Across multiple countries, the impact of pain on analgesic dependence was mediated by frequency of analgesic use rather than overuse or abuse, and self-reported need for analgesics was the strongest independent predictor of dependence. Asking people directly about their feelings of needing analgesics could therefore identify those who could be helped to use analgesics less frequently, which should reduce their risk of dependence.

Development and validation of a short-form Pain Medication Attitudes Questionnaire (PMAQ-14).

Attitudes to pain medication are important aspects of adjustment to chronic pain. They are measured by the 47-item Pain Medication Attitudes Questionnaire (PMAQ). To measure those attitudes more quickly and easily, we developed and evaluated a 14-item PMAQ using data from 3 separate surveys of people with pain in the general population. In survey 1, participants (n = 295) completed the 47-item PMAQ and measures of pain, analgesic use, analgesic dependence, and attitudes to self-medication. For each of the 7 PMAQ scales, the 2 items that best preserved the content of the full parent scales were identified using correlation and regression. The 2-item and full parent scales had very similar relationships with other measures, indicating that validity had been maintained. The resulting 14-item PMAQ was then completed by participants in survey 2 (n = 241) and survey 3 (n = 147), along with the same other measures as in survey 1. Confirmatory factor analysis showed that the 14-item PMAQ retained the 7-factor structure of the 47-item version, and correlations with other measures showed that it retained the validity of the 47-item version. The PMAQ scale Need was the most significant independent predictor of analgesic dependence in each of 4 separate multiple regression analyses. This short form of the PMAQ allows attitudes to pain medications to be measured in a valid and more efficient way.