Outcomes of prescription opioid dose escalation for chronic pain: results from a prospective cohort study.
Journal
Pain
ISSN: 1872-6623
Titre abrégé: Pain
Pays: United States
ID NLM: 7508686
Informations de publication
Date de publication:
06 2020
06 2020
Historique:
pubmed:
28
1
2020
medline:
15
5
2021
entrez:
28
1
2020
Statut:
ppublish
Résumé
The use of long-term opioid therapy for chronic pain remains common, yet data on long-term outcomes, especially after dose escalation, are sparse. This study examined potential benefits and harms associated with prescription opioid dose escalation. Participants from 2 institutions were enrolled in a 2-year prospective cohort study. All participants (n = 517) had a musculoskeletal pain diagnosis and were receiving a stable dose of long-term opioid therapy at baseline. Participants completed self-report measures of pain, disability, depression, and potential adverse effects at baseline and every 6 months for 2 years. We reviewed electronic health record data weekly to identify episodes of prescription opioid dose escalation; participants who had increases in their dose were seen for additional research visits within 1 month of dose escalation. Over 2 years, 19.5% of participants had prescription opioid dose increases. After controlling for covariates, there were no significant changes on any variable after dose escalation. Of those with a dose increase, 3% experienced a clinically meaningful improvement in pain after dose escalation. Participants in the entire sample had small improvements in pain intensity, depressive symptoms, medication-related side effects, and lower risk for prescription opioid misuse during the study period. Sexual functioning worsened over time. There were no significant changes in the full sample on pain disability, sleep functioning, or experiencing a fall. In summary, patients prescribed stable doses of long-term opioid therapy may demonstrate small changes in key pain-related outcomes over time, but prescription opioid dose escalation status is unrelated to clinical outcomes.
Identifiants
pubmed: 31985590
doi: 10.1097/j.pain.0000000000001817
pii: 00006396-202006000-00021
doi:
Substances chimiques
Analgesics, Opioid
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
1332-1340Subventions
Organisme : NIDA NIH HHS
ID : R01 DA034083
Pays : United States
Références
Buelow A, Haggard R, Gatchel RJ. Additional validation of the Pain Medication Questionnaire in a heterogenous sample of chronic pain patients. Pain Pract 2009;9:428–34.
Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory care quality improvement project (ACQUIP). Alcohol Use Disorders Identification Test. Arch Inter Med 1998;158:1789–95.
Busse JW, Wang L, Kamaleldin M, Craigie S, Riva JJ, Montoya L, Mulla SM, Lopes LC, Vogel N, Chen E, Kirmayr K, De Oliveira K, Olivieri L, Kaushal A, Chaparro LE, Oyberman I, Agarwal A, Couban R, Tsoi L, Lam T, Vandvik PO, Hsu S, Bala MM, Schandelmaier S, Scheidecker A, Ebrahim S, Ashoorion V, Rehman Y, Hong PJ, Ross S, Johnston BC, Kunz R, Sun X, Buckley N, Sessler DI, Guyatt GH. Opioids for chronic noncancer pain: a systematic review and meta-analysis. JAMA 2018;320:2448–60.
Chasens ER, Ratcliffe SJ, Weaver TE. Development of the FOSQ-10: a short version of the functional outcomes of sleep questionnaire. Sleep 2009;32:915–19.
Chen L, Sein M, Vo T, Amhmed S, Zhang Y, Hilaire KS, Houghton M, Mao J. Clinical interpretation of opioid tolerance versus opioid-induced hyperalgesia. J Opioid Manag 2014;10:383–93.
Chen L, Vo T, Seefeld L, Malarick C, Houghton M, Ahmed S, Zhang Y, Cohen A, Retamozo C, St Hilaire K, Zhang V, Mao J. Lack of correlation between opioid dose adjustment and pain score change in a group of chronic pain patients. J Pain 2013;14:384–92.
Chou R, Turner JA, Devine EB, Hansen RN, Sullivan SD, Blazina I, Dana T, Bougatsos C, Deyo RA. The effectiveness of and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention workshop. Ann Intern Med 2015;162:276–86.
Cifuentes M, Webster B, Genevav S, Pransky G. The course of opioid prescribing for a new episode of disabling low back pain. PAIN 2010;151:22–9.
Copeland LA, Zeber JE, Wang CP, Parchman ML, Lawrence VA, Valenstein M, Miller AL. Patterns of primary care and mortality among patients with schizophrenia or diabetes: a cluster analysis approach to the retrospective study of healthcare utilization. BMC Health Serv Res 2009;9:127.
Currow DC, Phillips J, Clark K. Using opioids in general practice for chronic non-cancer pain: an overview of current evidence. Med J Aust 2016;204:305–9.
Deyo RA, Smith DHM, Johnson ES, Tillotson CJ, Donovan M, Yang X, Petrik A, Morasco BJ, Dobscha SK. Prescription opioids for back pain and use of medications for erectile dysfunction. Spine 2013;38:909–15.
DiBenedetto DJ, Wawrzyniak KM, Finkelman M, Kulich RJ, Chen L, Schatman ME, Stone MT, Mao J. Relationships between opioid dosing, pain severity, and disability in a community-based chronic pain population: an exploratory retrospective analysis. Pain Med 2019;20:2155–65.
Dobscha SK, Lovejoy TI, Morasco BJ, Kovas AE, Peters DM, Hart K, Williams JL, McFarland BH. Predictors of improvements in pain intensity in a national cohort of older veterans with chronic pain. J Pain 2016;17:824–35.
Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States. JAMA 2016;315:1624–45.
Edlund MJ, Steffick D, Hudson T, Harris KM, Sullivan M. Risk factors for clinically recognized opioid abuse and dependence among veterans using opioid for chronic non-cancer pain. PAIN 2007;129:355–62.
Edwards RR, Wasan AD, Michna E, Greenbaum S, Ross E, Jamison RN. Elevated pain sensitivity in chronic pain patients at risk for opioid misuse. J Pain 2011;12:355–62.
Els C, Jackson TD, Kunyk D, Lappi VG, Sonnenberg B, Hagtvedt R, Sharma S, Kolahdooz F, Straube S. Adverse events associated with medium- and long-term use of opioids for chronic non-cancer pain: an overview of Cochrane reviews. Cochrane Database Syst Rev 2017;10:CD012509.
Evans CJ, Trudeau E, Mertzanis P, Marquis P, Peña BM, Wong J, Mayne T. Development and validations of the Pain Treatment Satisfaction Scale (PTSS): a patient satisfaction questionnaire for use in patients with chronic or acute pain. PAIN 2004;112:254–66.
Funk MJ, Westreich D, Wiesen C, Sturmer T, Brookhart MA, Davidian M. Doubly robust estimation of causal effects. Am J Epidemiol 2011;173:761–7.
Glanz JM, Binswanger IA, Shetterly SM, Narwaney KJ, Xu S. Association between opioid dose variability and opioid overdose among adults prescribed long-term opioid therapy. JAMA Netw Open 2019;2:e192613.
Han H, Kass PH, Wilsey BL, Li CS. Age, gender, and earlier opioid requirement associations with the rate of dose escalation in long-term opioid therapy. J Opioid Manag 2013;9:129–38.
Henry SG, Wilsey BL, Melnikow J, Iosif AM. Dose escalation during the first year of long-term opioid therapy for chronic pain. Pain Med 2015;16:733–44.
Holmes CP, Gatchel RJ, Adams LL, Stowell AW, Hatten A, Noe C, Lou L. An opioid screening instrument: long-term evaluation of the utility of the Pain Medication Questionnaire. Pain Pract 2006;6:74–88.
Ilgen MA, Bohnert ASB, Chermack S, Conran C, Jannausch M, Trafton J, Blow FC. A randomized trial of a pain management intervention of adults receiving substance use disorder treatment. Addiction 2016;111:1385–93.
Katz N, Mazer NA. The impact of opioids on the endocrine system. Clin J Pain 2009;25:170–5.
Krebs EE, Gravely A, Nugent S, Jensen AC, DeRonne B, Goldsmith ES, Kroenke K, Bair MJ, Noorbaloochi S. Effect of opioid vs nonopioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain: the SPACE randomized clinical trial. JAMA 2018;319:872–82.
Lozier CC, Nugent SM, Smith NX, Yarborough BJ, Dobscha SK, Deyo RA, Morasco BJ. Correlates of use and perceived effectiveness of non-pharmacologic strategies for chronic pain among patients prescribed long-term opioid therapy. J Gen Intern Med 2018;33:S46–53.
Martinez-Calderon J, Jensen MP, Morales-Asencio JM, Lugue-Suarez A. Pain catastrophizing and function in individuals with chronic musculoskeletal pain: a systematic review and meta-analysis. Clin J Pain 2019;35:279–93.
Martinez-Calderon J, Zamorea-Campos C, Navarro-Ledesma S, Lugue-Suarez A. The role of self-efficacy on the prognosis of chronic musculoskeletal pain: a systematic review. J Pain 2018;19:10–34.
Morasco BJ, O'Hearn D, Turk DC, Dobscha SK. Associations between prescription opioid use and sleep impairment among veterans with chronic pain. Pain Med 2017;18:437–45.
Morasco BJ, Yarborough BJ, Smith NX, Dobscha SK, Deyo RA, Perrin NA, Green CA. High prescription opioid dose is associated with worse patient-reported pain outcomes and more health care utilization. J Pain 2017;18:437–45.
Naliboff BD, Wu SM, Schieffer B, Bolus R, Pham Q, Baria A, Aragaki D, Van Wort W, Davis F, Shekelle P. A randomized trial of 2 prescription strategies for opioid treatment of chronic nonmalignant pain. J Pain 2011;12:288–96.
Nicholas MK. The Pain Self-Efficacy Questionnaire: taking pain into account. Eur J Pain 2007;11:153–63.
Salas J, Scherrer JF, Schneider FD, Sullivan MD, Bucholz KK, Burroughs T, Copeland LA, Ahmedani BK, Lustman PJ. New-onset depression following stable, slow, and rapid rate of prescription opioid dose escalation. PAIN 2017;158:306–12.
Selim AJ, Fincke G, Ren XS, Lee A, Rogers WH, Miller DR, Skinner KM, Linzer M, Kazis LE. Comorbidity assessments based on patient report: results from the Veterans Health Study. J Ambul Care Manage 2004;27:281–95.
Sherbourne CD. Social functioning; Sexual problems measure. In: Stewart AL, Ware JE, editors. Measuring functioning and well-being: The Medical Outcomes Study approach. Durham: Duke University Press, 1992. p. 194–204.
Skinner HA. The drug abuse screening test. Addict Behav 1982;7:363–71.
Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary care evaluation of mental disorders. Patient Health Questionnaire. JAMA 1999;282:1737–44.
Spooner L, Fernandes K, Martins D, Juurlink D, Mamdani M, Paterson JM, Singh S, Gomes T. High-dose opioid prescribing and opioid-related hospitalization: a population-based study. PLoS One 2016;11:e0167479.
Sullivan MJ, Bishop SR, Pivik J. The pain catastrophizing scale: development and validation. Psychol Assess 1995;7:524–32.
Turk DC. Clinical effectiveness and cost-effectiveness of treatments for patients with chronic pain. Clin J Pain 2002;18:355–65.
Turner JA, Shortreed SM, Saunders KW, LeResche L, Von Korff M. Association of levels of opioid use with pain and activity interference among patients initiating chronic opioid therapy: a longitudinal study. PAIN 2016;157:849–57.
Von Korff M, Ormel J, Keefe FJ, Dworkin SF. Grading the severity of chronic pain. PAIN 1992;50:133–49.
Waddell G, Newton M, Henderson I, Somerville D, Main CJ. A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. PAIN 1993;52:157–68.
Walker JM, Farney RJ. Are opioids associated with sleep apnea? A review of the evidence. Curr Pain Headache Rep 2009;13:120–6.
Williams AC, Eccleston C, Morley S. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev 2012;11:CD007407.
Zhang Y, Ahmed S, Vo T, St Hilaire K, Houghton M, Cohen AS, Mao J, Chen L. Increased pain sensitivity in chronic pain subjects on opioid therapy: a cross-sectional study using quantitative sensory testing. Pain Med 2015;16:911–22.