• Katherina Kipping, Christoph Maier, Heinz H Bussemas, and Andreas Schwarzer.
• Department of Pain Management, BG Universitatsklinikum Bergmannsheil GmbH, Ruhr University Bochum, Germany.
• Pain Physician. 2014 Jan 1; 17 (1): 81-94.

BackgroundDespite hints about the high incidence of pain patients misreporting their pain medication use, there are only a few non-controlled studies on the topic that focus solely on opioids.ObjectiveUsing toxicological analyses in a cross-sectional study, we investigated patients' reliability regarding their report of any current pain medication use.Study DesignA cross-sectional study.SettingA comprehensive pain center and a surgical unit of a German University Hospital.MethodsConsecutive outpatients at their first visit to the pain clinic (PG, n = 243) and pre-surgical control patients (SG, n = 100) suffering from pain reported on their current pain medication. The patients' reports were verified in serum and urine using specific toxicological methods. Two types of noncompliance were defined: under-reporting (detection of non-reported substances) and over-reporting (reported substances undetectable). The impact of clinical parameters on compliance was investigated using binary logistic regression.ResultsThe incidence of noncompliance was significantly higher in the PG (43.3%) than in the SG (24%; P < 0.05). Under-reporting occurred similarly in both groups (31% PG; 23% SG), whereas over-reporting predominantly appeared in the PG (11% vs. 2%; P < 0.05). Opioids were not most frequently under-reported, but the highest proportion of under-reported drugs (under-reported in relation to detection incidence) was found for non-opioid analgesics (NSAIDs: 29% PG; 25% SG; other: 42% PG; 32% SG) and psychotropic drugs (35% PG; 53% SG). In the PG, logistic regression revealed high depression scores to be predictive for noncompliance (odds ratio 2.12).LimitationsDue to lack of a structured follow-up interview motives of under- and over-reporting stay speculative.ConclusionsUnder-reporting of non-opioid analgesics is the main type of noncompliance, a disquieting fact in light of their toxicity and adverse effects. Further research is required in terms of drug assessment and compliance improvement strategies in pain clinics; therefore, toxicological monitoring is indispensable.Clinical TrialNCT01625065; Medi-3889-10.

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