The Role of Environmental Context and Physical Activity in Prescribed Opioid Use and Pain in Daily Life among Patients With Chronic Low Back Pain

Abstract

Abstract Background Prescription opioids remain a primary treatment option for patients with chronic low back pain. However, little research has examined how patients take opioids in daily life. Behavioral economics suggest that the environmental context may contribute to patients’ decisions around opioid use. Purpose This study examined the association of self-reported environmental factors and physical activity with likelihood of taking opioids, opioid dosage, and physical pain. Method Patients with chronic low back pain on long-term opioid therapy (n = 34) without significant past-year opioid-related problems completed a two-week ecological momentary assessment protocol (nobservations = 1,714). Results Initial multilevel models revealed multiple associations for different specific contexts with opioid use and pain. In models that collapsed specific contexts into categories (where, with whom, doing what), greater occasion-level physical activity was associated with a greater likelihood of taking opioids and greater pain, and being somewhere (v. at home) was associated with taking a smaller opioid dose. At any given occasion, being with someone (v. alone) was associated with taking a larger opioid dose, but patients who spent more time with others over the entire study took fewer opioids overall. Multilevel mediation found that pain did not mediate the association of physical activity and opioid use. Conclusion Results suggest that prescribed opioid use in patients with chronic low back pain is not solely determined by pain, but influenced by environmental factors, including physical activity. Psychoeducation regarding environmental factors, including how factors may be associated with both increased and decreased use of opioids, may help patients take fewer opioids more effectively.