Abstract
Despite the increasing use of opioid analgesics for chronic pain management, it is
unclear whether opioid dose escalation leads to better pain relief during chronic
opioid therapy. In this study, we retrospectively analyzed clinical data collected
from the Massachusetts General Hospital Center for Pain Medicine over a 7-year period.
We examined 1) the impact of opioid dose adjustment (increase or decrease) on clinical
pain score; 2) gender and age differences in response to opioid therapy; and 3) the
influence of clinical pain conditions on the opioid analgesic efficacy. A total of
109 subjects met the criteria for data collection. We found that neither opioid dose
increase, nor decrease, correlated with point changes in clinical pain score in a
subset of chronic pain patients over a prolonged course of opioid therapy (an average
of 704 days). This lack of correlation was consistent regardless of the type of chronic
pain including neuropathic, nociceptive, or mixed pain conditions. Neither gender
nor age differences showed a significant influence on the clinical response to opioid
therapy in these subjects. These results suggest that dose adjustment during opioid
therapy may not necessarily alter long-term clinical pain score in a group of chronic
pain patients and that individualized opioid therapy based on the clinical effectiveness
should be considered to optimize the treatment outcome.
Perspective
The study reports a relationship, or lack thereof, between opioid dose change and
clinical pain score in a group of chronic pain patients. The study also calls for
further investigation into the effectiveness of opioid therapy in the management of
chronic nonmalignant pain conditions.
Key words
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Article info
Publication history
Published online: February 28, 2013
Accepted:
December 11,
2012
Received in revised form:
December 5,
2012
Received:
October 16,
2012
Footnotes
This work was supported by NIH grants RO1 DA022576, P20 DA026002, and RO1 AT005819.
The authors claim no conflict of interest related to this study.
Identification
Copyright
© 2013 American Pain Society. Published by Elsevier Inc. All rights reserved.
