Rationale aims and objectivesː A good therapeutic alliance or relationship is relevant for healthcare providers exposed to patients’ suffering, especially when patients and physicians may understand the painful experience differently. Our aim was to explore the impact of therapeutic alliance on analgesic outcomes in a real-world Pain Unit. Methodː A cross-sectional observational study was conducted on ambulatory patients (n=69) who use pain killers long-term during treatment of chronic non-cancer pain. Responses to a patient-doctor relationship questionnaire were correlated with levels of comprehension of prescription information provided during consultations. Socio-demographical and clinical information (pain level, quality of life and hospital use) were collected through the questionnaire, while pharmacology data (analgesic prescription, adverse events, and compliance) were obtained from electronic health records. Resultsː Patients were 75% middle-aged women, 72% retired, experiencing moderate pain on average, and under a high morphine equianalgesic dosage (95 ± 88 mg/day, mainly tapentadol or fentanyl). Patients with low therapeutic alliance showed a significantly higher pain intensity (80 ± 75 mm, p<0.01). In contrast, patients who reported high therapeutic alliance during the treatment reached a significant result of 35% lower pain intensity (d=1.079), 52% higher relief (d=0.675) and 48% better quality of life (d=0.638). Moreover, pain intensity was significantly lower when patients affirmed that, thanks to their doctors, they had gained new insights (d=0.574), felt better (d=0.756), or felt content with or benefit from the treatment of my doctor (d=0.826). A total of 65% of the full patient population reported the ability to manage their symptoms as well as better opioid knowledge, increasing their observed drug compliance by 15%. Conclusionsː Therapeutic alliance can be an effective strategy for impacting analgesic outcomes, as evidences in a real-world chronic pain clinical setting. More effort is necessary to improve communication strategies for pain management.

Background and purpose: Tapentadol (TAP) and oxycodone/naloxone (OXN) are available formulations that potentially offer improved gastrointestinal tolerability. However, real-world studies in chronic non-cancer pain (CNCP) remain scarce. The aim is to analyse their benefit/risk profiles and the influence of pharmacogenetic markers in daily pain practice. Experimental approach: A prospective, controlled study was developed with ambulatory CNCP patients. Cases were treated with TAP (n=204) or OXN (n=180) prescription, and controls other opioids (n=216). Pain intensity and relief, quality of life, morphine equivalent daily doses (MEDD), adverse events (AEs) and hospital admissions were registered. OPRM1 (rs1799971, A118G) and COMT (rs4680, G472A) gene variants were also analysed. Key Results: Cases evidenced a significantly higher pain relief than control did in real-world management. Here, pain intensity and quality of life were predictive values of relief (R2=0.3). OXN achieved greater pain relief under higher 28% MEDD, 15% pregabalin and 8% duloxetine than TAP. Additionally, OXN needed 15-23% more prescription changes. What´s more, OXN presented the highest rate of AEs at 6 (3-9) per person, including a 68% prevalence of constipation and 24% of erythema. COMT-AA showed higher rates of erythema and vomiting, especially in females. Conclusions and Implications: OXN and TAP exhibited optimal benefit/risk profiles for improving pain relief in real-world CNCP. However, increased OXN pain relief conditioned patients for higher MEDDs, constipation side-effects and drug prescription changes than TAP. Further research is necessary to clarify a potential sex-bias in and genetic influence on side-effects.