Potential risk factors associated with risk for drop-out and relapse during and following withdrawal of opioid prescription medication

Eur J Pain. 2011 Oct;15(9):966-70. doi: 10.1016/j.ejpain.2011.03.006. Epub 2011 May 4.


Background: Withdrawal of opioid medication in patients with chronic pain has a drop-out and relapse problem.

Aim: To evaluate if depressive symptoms, anxiety and pain intensity are potential risk factors for drop-out or relapse during the withdrawal process. Further, to assess internal consistency of scales for assessment of these potential risk factors.

Methods: Twenty-nine patients were included. After 2 years 28 of these were followed-up.

Results: Those with depressive symptoms at baseline had a significant risk for drop-out from the withdrawal program (odds ratio 1.37) and relapse into use of opioids at follow-up (odds ratio 1.44). Drop-outs rated depressive symptoms significantly higher before detoxification. Those who relapsed rated significantly higher for pain intensity, depressive symptoms and abstinence prior to withdrawal. All scales had high reliability.

Perspective: To avoid drop-out and relapse clinical practice need to screen for depressive symptoms, pain intensity, and abstinence. This article presents significant reliability of scales useful within dependency centers. They can be used to identify these risk factors for drop-out and relapse, respectively, when initiating the withdrawal process. Taking these risk factors into consideration could improve the outcome of the withdrawal process by preventing drop-out and relapse.

MeSH terms

  • Adult
  • Aged
  • Analgesics, Opioid / administration & dosage
  • Analgesics, Opioid / adverse effects*
  • Analgesics, Opioid / therapeutic use
  • Anxiety / psychology
  • Chronic Pain / drug therapy*
  • Depression / psychology
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Pain Measurement
  • Patient Dropouts / psychology*
  • Recurrence
  • Risk Factors
  • Substance Withdrawal Syndrome / psychology*


  • Analgesics, Opioid