Driving with chronic pain. First, any honest discussion of impairment has to start with the pain itself

Driving with chronic pain. First, any honest discussion of impairment has to start with the pain itself. Uncontrolled chronic pain impairs concentration, slows reaction time, and limits physical movement — checking a blind spot, sitting in a seat for a long stretch. 

Effective pain management can restore that focus. That doesn't mean medication side effects get ignored; they have to be weighed in every case. The point is that each patient must be judged individually, on actual performance, not excluded by a blanket rule. A blanket rule assumes the medication itself impairs driving; the research below tests that assumption directly, and for patients on a stable dose, it does not hold.

What the studies found

Byas-Smith and Chapman, 2005. In a study published in The Clinical Journal of Pain, 21 chronic pain patients on stable opioid doses (an average of 118 mg morphine equivalent per day) were compared with 50 healthy volunteers and 11 pain patients not taking opioids. Participants drove their own cars on town and highway routes, completed a five station obstacle course, and took attention tests, with no significant differences between the groups. The authors concluded: "Many patients with chronic pain, even if treated with potent analgesics such as morphine and hydromorphone, show comparable driving ability as normals."

Buvanendran, Rush University, 2007. In a driving-simulator study of 51 patients on regular oral morphine and 49 controls, the groups were effectively identical: weaving of 3.83 feet in both, 5.33 versus 5.04 collisions, and reaction times of 0.69 versus 0.67 seconds. This was a conference presentation to the American Society of Anesthesiologists, not a peer-reviewed journal article, and the Board should weigh it accordingly.

Fishbain's 2003 review of 48 studies reached the same conclusion: opioids do not impair driving-related skills in opioid tolerant patients in four of five areas tested. Untreated chronic pain itself also impairs attention and processing speed.

Safeguards I propose

A stable dose for at least four weeks, with no increase and no breakthrough medication

Written physician clearance stating there is no sedation or cognitive impairment

No sedating co-medications, such as benzodiazepines, muscle relaxants, or sleep aids. A demonstrated driving evaluation in the apparatus the volunteer would operate. No driving during any dose change, with periodic re-evaluation

1. Byas-Smith MG, Chapman SL, et al. "The Effect of Opioids on Driving and Psychomotor Performance in Patients With Chronic Pain." Clinical

Journal of Pain, 2005; 21(4):345-352. DOI: 10.1097/01.ajp.0000125244.29279.c1

2. Fishbain DA, et al. Review of driving performance in opioid-dependent/tolerant patients. Journal of Pain and Symptom Management, 2003. https://

pubmed.ncbi.nlm.nih.gov/12782437/

3. Buvanendran A, et al. Rush University Medical Center. Morphine driving-simulator study in patients on regular oral morphine. Conference presentation to the American Society of Anesthesiologists, 2007