Risk Factors for Self-Harm Ideation Among Persons Treated With Opioids for Chronic Low Back Pain.

OBJECTIVES: Chronic pain is a significant health concern that adversely affects all aspects of life, including emotional well-being. Opioids are prescribed for the management of refractory, severe chronic pain, although they have been associated with adverse effects, including addiction and overdose. The aim of this study was to examine factors that predict thoughts of self-harm among adults with chronic pain who are prescribed opioids. MATERIALS AND METHODS: Seven hundred sixty-five (N=765) persons with opioid-treated chronic lower back pain completed the Current Opioid Misuse Measure (COMM) and other validated questionnaires as part of a larger study. Response to 1 question from the COMM ("How often have you seriously thought about hurting yourself?") was used to assess suicide risk on a 5-point scale (0=never; 4=very often). RESULTS: Participants were categorized into 3 groups according to their responses to the self-harm question: never (N=628; 82.1%), seldom or sometimes (N=74; 9.7%), and often or very often (N=63; 8.2%). Multivariate adjusted odds ratio (aOR) analyses indicated that reports of alcohol or drug overuse within the past month (aOR=1.41,[95% CI 1.11-1.78]), posttraumatic stress (PTSD; aOR=1.24,[1.07 to 1.44]), pain catastrophizing (aOR=1.03,[1.01 to 1.05]), not loving oneself (aOR=0.99,[.98-1.00]) and poor perceived mental health (aOR=0.94,[.92 to 97]) were most associated with thoughts of self-harm. Importantly, the ideation frequency of self-harm was highest among individuals treated with higher daily doses of opioids. DISCUSSION: These results support the need for continued monitoring of adults treated with opioids for chronic pain, particularly among those on high-dose opioids who present with increased negative affect and concerns of substance misuse.

Using timed event sequential data in nursing research.

BACKGROUND: Measuring behavior is important in nursing research, and innovative technologies are needed to capture the "real-life" complexity of behaviors and events. PURPOSE: The purpose of this article is to describe the use of timed event sequential data in nursing research and to demonstrate the use of this data in a research study. DISCUSSION: Timed event sequencing allows the researcher to capture the frequency, duration, and sequence of behaviors as they occur in an observation period and to link the behaviors to contextual details. Timed event sequential data can easily be collected with handheld computers, loaded with a software program designed for capturing observations in real time. CONCLUSION: Timed event sequential data add considerable strength to analysis of any nursing behavior of interest, which can enhance understanding and lead to improvement in nursing practice.