Moreover, patients who had been prescribed a stable dose of long-term opioid therapy demonstrated few clinically significant changes in pain-related outcomes over time, reported Benjamin Morasco, PhD, of Oregon Health & Science University in Portland, and colleagues, at the American Pain Society Scientific Meeting.
Long-term opioid therapy is a common treatment for chronic pain, and “little data are available about the benefits and harms associated with increasing opioid dose,” Morasco told MedPage Today. “It’s unclear to what extent escalating opioid doses can improve pain, yet still have the risk-benefit ratio of a lower dose.”
For this study, Morasco and colleagues recruited 517 adults with a chronic musculoskeletal pain from the Kaiser Permanente Northwest and Veteran Affairs (VA) Portland health care system who were prescribed a stable dose of long-term opioid therapy. The researchers excluded patients who were receiving opioids for cancer treatment or palliative care, had pending a disability claim related to a pain condition, had enrolled in an opioid substitution program in the past year, had a current opioid dose >120 mg, or whose opioid prescriptions were solely tramadol or buprenorphine.
Participants were an average age of about 60, and just under half were female. All participants completed standardized questionnaires — including measurements of pain intensity and pain interference on 100-point scales — every 6 months for 2 years. Researchers reviewed medical records each week; patients who had an opioid dose increase completed an additional questionnaire within 4 weeks of dose escalation.
The average daily opioid dose at baseline was 36.2 mg morphine equivalent dose (MED). Of the 517 participants who enrolled, 19.5% (n=101) had a prescription opioid dose increase of 15% or more from their baseline dose. The baseline dose of these 101 patients was 27 MED; the baseline dose of patients who didn’t have an increase (n=416) was 39 MED. The average increase in prescription opioid dose from baseline was 104%.
After controlling for covariates — medical comorbidities, alcohol and substance use, pain catastrophizing, pain self-efficacy, complementary and integrative treatments for chronic pain, and other factors — the researchers found no significant changes in pain intensity or pain interference over time, and no differences based on dose escalation status. Specifically:
- Average pain intensity score decreased by 0.79 points a year, and there was no difference in average pain intensity based on dose increase status
- Average pain interference increased by 1.42 points per year; this also showed no difference based on dose increase status
- No significant changes in depression severity or sexual functioning over time emerged, and no difference was seen based on dose increase status
- On average, those in the dose increase group had higher scores on risk for prescription opioid misuse, but they also had greater average reductions in risk over time
- Those in the dose increase group had poorer sleep functioning compared to those in the stable dose group on average, and there were no differences in change over time
- The average score for short-term medication-related side effects such as constipation, nausea, and vomiting decreased over time, and there was no difference based on dose increase status
“Clinically, we are seeing more and more people having increases in opioid doses,” said Morasco. “This is one of the first prospective studies to see the outcomes of opioid dose escalation.”
“We didn’t really see long-term improvements,” Morasco added. “People may have had changes in pain intensity soon after dose escalation, but when we really follow them for up to a year after their dose escalation, we don’t see long-term changes.”
The study was supported by the National Institute of Drug Abuse.
No comments:
Post a Comment
Note: Only a member of this blog may post a comment.