The effect of opioids on driving and psychomotor performance in patients with chronic pain

Objectives: This study compared the psychomotor performance and driving ability of patients with chronic pain managed with stable regimens of opioid analgesics with that of normal healthy volunteers. The hypothesis was that patients with chronic pain on stable opioid analgesic regimens operate their automobiles safely with proficiency equal to normal volunteer controls. Methods: Patients were evaluated for errors while driving their own automobile through a predetermined route in the community, including variable residential and highway conditions, and for speed and accuracy on repeated trials through a 5-station obstacle course that evaluated forward and reverse driving, turning, and parallel parking. Patients also completed the Test of Variables of Attention and the Digit Symbol Substitution Test. Results: No significant differences were observed among groups in driving performance in the community and on the obstacle course or on the Test of Variables of Attention. Results on dependent measures within the opioid group generally were not correlated with morphine equivalent daily opioid doses, which averaged 118 mg (median 40 mg). Conclusions: Many patients with chronic pain, even if treated with potent analgesics such as morphine and hydromorphone, show comparable driving ability as normals.