Relationships Between Opioid Dosing, Pain Severity, and Disability in a Community-Based Chronic Pain Population: An Exploratory Retrospective Analysis

Abstract

Objective. To determine the relationship between opioid dose change, pain severity, and function in patients with chronic pain. Design. Retrospective cohort study. Setting. Community interdisciplinary pain management practice. Subjects. A total of 778 patients with chronic pain prescribed opioids for three or more consecutive months between April 1, 2013, and March 1, 2015. Methods. Changes in opioid dose, pain severity rating, modified Roland Morris Disability Questionnaire score, and opioid risk data were extracted from medical records and analyzed for associations. Results. Two hundred forty-three subjects (31.2%) had an overall dose decrease, 223 (28.7%) had a dose increase, and 312 (40.1%) had no significant change in dose (<20% change). There was a weak negative correlation between change in opioid dose and change in pain severity (r = –0.08, P = 0.04) but no association between change in disability scores and dose change (N = 526, P = 0.13). There was a weak positive correlation between change in pain severity rating and change in disability scores (r = 0.16, P < 0.001). Conclusions. The results suggest that escalating opioid doses may not necessarily result in clinically significant improvement of pain or disability. Similarly, significant opioid dose reductions may not necessarily result in worsened pain or disability. This exploratory investigation raised questions of possible subgroups of patients who might demonstrate improvement of pain and disability with opioid dose adjustments, and further research should prospectively explore this potential, given the limitations inherent in retrospective analyses. Prescribers should still consider reduction of opioid doses as recommended by current guidelines, in an effort to mitigate the potential risks associated with high-dose treatment.

Benefits and Harms of Long-term Opioid Dose Reduction or Discontinuation in Patients with Chronic Pain: a Rapid Review

“…Among 3,155 potentially relevant citations, we included 49 studies-1 systematic review (Frank et al), 8 34 studies included in that systematic review,, and 14 new studies identified in our literature search. [50][51][52][53][54][55][56][57][58][59][60][61][62][63] A total of 40,245 patients are included in the 14 new studies.…”

“…We prioritized evidence synthesis of: 1) studies conducted in a VHA setting or other outpatient settings; 2) studies that addressed serious harms such as overdose and suicide; and 3) studies that included enough detail regarding patient and tapering characteristics to evaluate the applicability of findings to VHA populations and settings. Nineteen studies (Table 1) (2 RCTs, 18, 50 6 controlled observational studies, 54,56,[60][61][62][63] and 11 uncontrolled observational studies) 27,30,32,34,36,40,55,[57][58][59]65 met these criteria, which we refer to as "prioritized studies." The remaining studies either had low applicability to VHA or outpatient settings or included patients or interventions that were not well-described.…”

The Role of Pain Catastrophizing and Pain Acceptance in Performance-Based and Self-Reported Physical Functioning in Individuals with Fibromyalgia and Obesity

“…To date, research into physical functioning in individuals with chronic pain and FM has mostly relied on self-report measures [ 25 , 41 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 ]. Performance-based measures, which focus on actual rather than perceived functional ability, have generally been neglected.…”

Impact of opioid dose escalation on the development of substance use disorders, accidents, self‐inflicted injuries, opioid overdoses and alcohol and non‐opioid drug‐related overdoses: a retrospective cohort study

“…Dose escalation was defined as at least a 20% increase in average daily MME dose in the second 180‐day period compared to the initial 180‐day period. Dose maintenance was defined as an average daily dose in the second period that was within ± 20% of the average daily dose of the initial period . Those who experienced a dose decrease of 20% or greater were excluded.…”