Chronic pain severity, impact, and opioid use among patients with cancer: An analysis of biopsychosocial factors using the CHOIR learning health care system

Background: Many biopsychosocial factors influence outcomes of chronic non-cancer pain, but relatively little is known regarding their influence on chronic cancer pain symptoms. We aimed to characterize associations between biopsychosocial factors and pain outcomes among individuals with chronic cancer pain. Methods: We conducted a retrospective, cross-sectional study of 700 patients with chronic cancer pain seeking treatment at an academic tertiary pain clinic. Patients completed demographics questionnaires and validated psychosocial and pain measures. We performed multivariable hierarchical linear and logistic regressions to assess the relative contributions of biopsychosocial factors on pain outcomes (pain severity, pain interference, and opioid use). Results: Participants were 62% female, 64% Caucasian, with a mean age of 5915 years, and 55% held a college degree or higher. Older age, African-American or “other” race, sleep disturbance, and pain catastrophizing were significantly associated with higher pain severity [F(5,657)=22.45***, p<.001;R2 =.22]. Depression, sleep disturbance, and pain catastrophizing, lower emotional support, and higher pain severity were significantly associated with pain interference [F(5,653)=9.47, p<.001;R2 =.21]. Lastly, a poor cancer prognosis [Exp(B)=.45], antidepressant use, and sleep disturbance [Exp(B)=1.02] were associated with taking opioids, while identifying as Asian or Hispanic [Exp(B)=.48 & .47] was associated with lower odds of using opioid analgesics. Conclusion: Certain demographic and psychosocial factors were associated with pain and opioid use, including potentially modifiable risk factors such as sleep disturbance, depression, and pain catastrophizing, which future behavioral interventions may target to improve pain outcomes among patients with cancer.