Understanding quality of life in chronic non-cancer pain: untangling the associations between medication use, psychosocial functioning, and stigma

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Abstract
To explore the relationships between pain medication use and quality of life in individuals with chronic non-cancer pain (CNCP), with a focus on three domains: pain severity, well-being and psychosocial functioning, and stigma experiences. A secondary analysis was conducted using cross-sectional data from an online Belgian survey. The sample consisted of 332 participants with CNCP (Mage = 54 years; 82% women; 18% men). Participants were categorized into four groups: individuals taking (1) no medication, (2) non-opioids, (3) mild/weak opioids, or (4) strong opioids. Pain grades were assigned using the Graded Chronic Pain Scale. Distribution of frequencies and Spearman's correlation were calculated for pain severity, while (multivariate) analysis of variance was used for all psychosocial outcomes. Participants classified in higher pain grades were more likely to use stronger opioids. Significant differences emerged between medication groups in well-being and functioning, as well as stigma experiences. Specifically, individuals in the strongest opioid group reported the highest levels of pain interference, social isolation, enacted and internalized stigma, alongside the lowest levels of physical functioning and social participation. After controlling for pain severity, only differences between medication groups in pain interference and physical functioning remained significant. In contrast, pain severity showed significant main effects across all outcomes: pain interference, physical functioning, social participation, social isolation, depressive symptoms, anxiety, and overall stigma. This study emphasizes the need for a multidisciplinary treatment approach, given that both pain severity and opioid use were associated with poorer quality of life among individuals with CNCP.
Funding Information
  • Fund for Scientific Research (FWO)-Flanders, Belgium (11K0421N)
  • Fund for Scientific Research (FWO)-Flanders, Belgium (G020118N)
  • Bijzonder Onderzoeksfonds UGent (BOF/IOP/2022/021)

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