Pain medication beliefs in individuals with headache
Abstract
Objective
To evaluate pain medication beliefs in a community sample of individuals with headache.
Background
Previous studies of medication adherence for individuals with headache have identified a high rate of prescription nonfulfillment, frequent medication discontinuation, and widely varying levels of medication-related satisfaction. Still, there is a limited understanding of how these individuals view their medications and their relationships with health-care providers. Insight into these perceptions could prove useful in explaining medication adherence behaviors.
Methods
In this secondary analysis of a cross-sectional study, data from N = 215 adults with headache were analyzed. Participants completed the Pain Medication Attitudes Questionnaire (PMAQ), Center for Epidemiologic Studies Depression Scale (CES-D), State–Trait Anxiety Inventory Form Y-2, Weekly Stress Inventory Short Form, and Migraine Disability Scale. These participants also provided a list of their current pain medications.
Results
Using the PMAQ, participants could be characterized as having medication beliefs that were “trusting and unconcerned” (n = 83/215 [38.6%]), “skeptical and somewhat worried” (n = 99/215 [46.0%]), or “skeptical and concerned” (n = 33/215 [15.3%]). Individuals with skeptical and concerned beliefs expressed elevated concerns (z > 1.15) about side effects, scrutiny, perceived need, tolerance, withdrawal, and addiction. Individuals who were trusting and unconcerned expressed low levels (z < −0.40) of these beliefs. Increasing levels of mistrust and medication concerns were correlated with higher depression scores on the CES-D, with values ranging from r = 0.23 to r = 0.38.
Conclusions
Subgroups of pain medication beliefs were identified, including two groups of patients with at least some concerns about their medical providers. Beliefs ranged from a lack of concern about using pain medications to worries about scrutiny and harm. It is unclear if poor experiences with pain medications cause these beliefs or if they prevent individuals from effectively utilizing medications. Additionally, more negative beliefs about pain medications were associated with more depressive symptoms.
CONFLICT OF INTEREST STATEMENT
Dr. Dana P. Turner receives a stipend from the American Headache Society for her role as Design and Methods Advisor of Headache. She receives research funding from the National Institutes of Health and the Department of Defense and book royalties from Springer Nature. Dr. Timothy T. Houle receives salary support from the American Society of Anesthesiologists and, until 2022, received a stipend from the American Headache Society for his role as Statistical Editor. He receives research funding from the National Institutes of Health and the Department of Defense. Julia Bertsch and Emily Caplis declare no conflicts of interest.
