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Higher Prescription Opioid Dose is Associated With Worse Patient-Reported Pain Outcomes and More Health Care Utilization

  • Benjamin J. Morasco
    Correspondence
    Address reprint requests to Benjamin J. Morasco, PhD, VA Portland Health Care System (R&D99), 3710 SW US Veterans Hospital Road, Portland, OR 97239.
    Affiliations
    Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon

    Department of Psychiatry, Oregon Health & Science University, Portland, Oregon
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  • Bobbi Jo Yarborough
    Affiliations
    Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
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  • Ning X. Smith
    Affiliations
    Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
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  • Steven K. Dobscha
    Affiliations
    Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon

    Department of Psychiatry, Oregon Health & Science University, Portland, Oregon
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  • Richard A. Deyo
    Affiliations
    Kaiser Permanente Northwest Center for Health Research, Portland, Oregon

    Departments of Family Medicine, Internal Medicine, and the Oregon Institute for Occupational Health Sciences, Oregon Health & Science University, Portland, Oregon

    Public Health and Preventive Medicine, Oregon Health & Science University, Portland, Oregon
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  • Nancy A. Perrin
    Affiliations
    Kaiser Permanente Northwest Center for Health Research, Portland, Oregon

    Public Health and Preventive Medicine, Oregon Health & Science University, Portland, Oregon
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  • Carla A. Green
    Affiliations
    Kaiser Permanente Northwest Center for Health Research, Portland, Oregon

    Public Health and Preventive Medicine, Oregon Health & Science University, Portland, Oregon
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Published:December 17, 2016DOI:https://doi.org/10.1016/j.jpain.2016.12.004

      Highlights

      • We compared group differences on the basis of prescription opioid dose.
      • Higher opioid dose was associated with poorer pain outcomes and more health care utilization.
      • Differences were detected among groups in rates of self-reported hazardous alcohol and substance use.

      Abstract

      Some previous research has examined pain-related variables on the basis of prescription opioid dose, but data from studies involving patient-reported outcomes have been limited. This study examined the relationships between prescription opioid dose and self-reported pain intensity, function, quality of life, and mental health. Participants were recruited from 2 large integrated health systems, Kaiser Permanente Northwest (n = 331) and VA Portland Health Care System (n = 186). To be included, participants had to have musculoskeletal pain diagnoses and be receiving stable doses of long-term opioid therapy. We divided participants into 3 groups on the basis of current prescription opioid dose in daily morphine equivalent dose (MED): low dose (5–20 mg MED), moderate dose (20.1–50 mg MED), and higher dose (50.1–120 mg MED) groups. A statistically significant trend emerged where higher prescription opioid dose was associated with moderately sized effects including greater pain intensity, more impairments in functioning and quality of life, poorer self-efficacy for managing pain, greater fear avoidance, and more health care utilization. Rates of potential alcohol and substance use disorders also differed among groups. Findings from this evaluation reveal significant differences in pain-related and substance-related factors on the basis of prescription opioid dose.

      Perspective

      This study included 517 patients who were prescribed long-term opioid therapy and compared differences on pain- and mental health-related variables on the basis of prescription opioid dose. Findings reveal small- to medium-sized differences on pain-related variables, alcohol and substance use, and health care utilization on the basis of the dose of opioid prescribed.

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