Analgesic use: a predictor of chronic pain and medication overuse headache: the Head-HUNT Study

• Published in: Neurology Vol. 61; no. 2; p. 160
• Main Authors: Zwart, J-A, Dyb, G, Hagen, K, Svebak, S, Holmen, J
• Format: Journal Article
• Language: English
• Published: United States 22.07.2003
• Subjects: Adult; Analgesics - adverse effects; Analgesics - therapeutic use; Chronic Disease; Drug Utilization - statistics & numerical data; Female; Follow-Up Studies; Headache - chemically induced; Headache - drug therapy; Headache - epidemiology; Humans; Low Back Pain - chemically induced; Low Back Pain - drug therapy; Low Back Pain - epidemiology; Male; Middle Aged; Migraine Disorders - chemically induced; Migraine Disorders - drug therapy; Migraine Disorders - epidemiology; Neck Pain - chemically induced; Neck Pain - drug therapy; Neck Pain - epidemiology; Norway - epidemiology; Pain - chemically induced; Pain - drug therapy; Pain - epidemiology; Prospective Studies; Risk; Substance-Related Disorders - complications; Substance-Related Disorders - epidemiology; Surveys and Questionnaires; Norway
• ISSN: 1526-632X
• DOI: 10.1212/01.WNL.0000069924.69078.8D

To examine the relation between analgesic use at baseline and the subsequent risk of chronic pain (> or =15 days/month) and the risk of analgesic overuse. In total, 32, 067 adults reported the use of analgesics in 1984 to 1986 and at follow-up 11 years later (1995 to 1997). The risk ratios (RR) of chronic pain and RR of analgesic overuse in the different diagnostic groups (i.e., migraine, nonmigrainous headache, neck pain, and low-back pain) were estimated in relation to analgesic consumption at baseline. Individuals who reported use of analgesics daily or weekly at baseline showed significant increased risk for having chronic pain at follow-up. The risk was most evident for chronic migraine (RR = 13.3, 95% CI: 9.3 to 19.1), intermediate for chronic nonmigrainous headaches (RR = 6.2, 95% CI: 5.0 to 7.7), and lowest for chronic neck (RR = 2.4, 95% CI: 2.0 to 2.8) or chronic low-back (RR = 2.3, 95% CI: 2.0 to 2.8) pain. Among subjects with chronic pain associated with analgesic overuse, the RR was 37.6 (95% CI: 21.3 to 66.4) for chronic migraine, 14.4 (95% CI: 10.4 to 19.9) for chronic nonmigrainous headaches, 7.1 for chronic neck pain (95% CI: 5.5 to 9.2), and 6.4 for chronic low-back pain (95% CI: 4.9 to 8.4). The RR for chronic headache (migraine and nonmigrainous headache combined) associated with analgesic overuse was 19.6 (95% CI: 14.8 to 25.9) compared with 3.1 (95% CI: 2.4 to 4.2) for those without overuse. Overuse of analgesics strongly predicts chronic pain and chronic pain associated with analgesic overuse 11 years later, especially among those with chronic migraine.