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.
Key words
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References
- Development of a self-report screening instrument for assessing potential opioid medication misuse in chronic pain patients.J Pain Symptom Manage. 2004; 27: 440-459
- Medical cannabis laws and opioid analgesic overdose mortality in the United States, 1999–2010.JAMA Intern Med. 2014; 174: 1668-1673
- Opioid therapy for chronic pain.N Engl J Med. 2003; 349: 1943-1953
- Trends in any and high-dose opioid analgesic receipt among aging patients with and without HIV.AIDS Behav. 2016; 20: 679-686
- A pilot randomized clinical trial of an intervention to reduce overdose risk behaviors among emergency department patients at risk for prescription opioid overdose.Drug Alcohol Depend. 2016; 163: 40-47
- Association between opioid prescribing patterns and opioid overdose-related deaths.JAMA. 2011; 305: 1315-1321
- Emergency department visits among recipients of chronic opioid therapy.Arch Intern Med. 2010; 170: 1425-1432
- The AUDIT alcohol consumption questions (AUDIT-C).Arch Intern Med. 1998; 158: 1789-1795
- The Pain and Opioids in Treatment (POINT) study: Characteristics of a cohort using opioids to manage chronic non-cancer pain.Pain. 2015; 156: 231-242
- Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain.J Pain. 2009; 10: 113-130
- The effectiveness 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: 276-286
- Psychometric properties of the Drug Abuse Screening Test in psychiatric outpatients.Psychol Assess. 1998; 10: 408-414
Department of Veterans Affairs and Department of Defense: VA/DoD clinical practice guideline for management of opioid therapy for chronic pain. Available at: http://www.healthquality.va.gov/Chronic_Opioid_Therapy_COT.asp. Accessed April 1, 2011
- CDC guideline for prescription opioids for chronic pain–United States, 2016.JAMA. 2016; 315: 1624-1645
- An evaluation of the predictive validity of the Pain Medication Questionnaire with a heterogeneous group of patients with chronic pain.J Opioid Manag. 2007; 3: 257-266
- Opioid prescriptions for chronic pain and overdose: A cohort study.Ann Intern Med. 2010; 152: 85-92
- Risk factors for clinically recognized opioid abuse and dependence among veterans using opioids for chronic non-cancer pain.Pain. 2007; 129: 355-362
- Changes in chronic pain severity over time: The Chronic Pain Grade as a valid measure.Pain. 2000; 88: 303-308
- Opioids for chronic non-cancer pain: A meta-analysis of effectiveness and side effects.Can Med Assoc J. 2006; 174: 1589-1594
- Less is more: Opioid dose and drug-related mortality in patients with nonmalignant pain.Arch Intern Med. 2011; 171: 686-691
- Persistent pain and well being: A World Health Organization study in primary care.JAMA. 1998; 280: 145-151
- Dose escalation during the first year of long-term opioid therapy for chronic pain.Pain Med. 2015; 16: 733-744
- An opioid screening instrument: Long-term evaluation of the utility of the Pain Medication Questionnaire.Pain Pract. 2006; 6: 74-88
- Changes in beliefs, catastrophizing, and coping are associated with improvement in multidisciplinary pain treatment.J Consult Clin Psychol. 2001; 69: 655-662
- Opioids in chronic non-cancer pain: Systematic review of efficacy and safety.Pain. 2004; 112: 372-380
- Psychological aspects of persistent pain: Current state of the science.J Pain. 2004; 5: 195-211
- Correlates of high-dose opioid medication use for low back pain in primary care.J Pain. 2012; 13: 1131-1138
- The PHQ-9: A new depression diagnostic and severity measure.Psychiatry Ann. 2002; 32: 1-7
- The PHQ-9: Validity of a brief depression severity measure.J Gen Intern Med. 2001; 16: 606-613
- Anxiety disorders in primary care: Prevalence, impairment, comorbidity, and detection.Ann Intern Med. 2007; 146: 317-325
- Cannabis as an adjunct to or substitute for opiates in the treatment of chronic pain.J Psychoactive Drugs. 2012; 44: 125-133
- Association between substance use disorder status and pain-related function following 12 months of treatment in primary care patients with musculoskeletal pain.J Pain. 2011; 12: 352-359
- Clinical characteristics of veterans prescribed high doses of opioid medications for chronic non-cancer pain.Pain. 2010; 151: 625-632
- Systematic review of prevalence, correlates, and treatment outcomes for chronic non-cancer pain in patients with comorbid substance use disorder.Pain. 2011; 152: 488-497
- Trends in prevalent and incident opioid receipt: An observational study in Veterans Health Administration 2004-2012.J Gen Intern Med. 2015; 30: 597-604
- The Pain Self-Efficacy Questionnaire: Taking pain into account.Eur J Pain. 2007; 11: 153-163
- Amending the fear-avoidance model of chronic pain: What is the role of physiological arousal?.Behav Ther. 2003; 34: 17-30
- Relationship of opioid use and dosage levels to fractures in older chronic pain patients.J Gen Intern Med. 2010; 25: 310-315
- New effect size rules of thumb.J Mod Appl Stat Methods. 2009; 8: 467-474
- The Drug Abuse Screening test.Addict Behav. 1982; 7: 363-371
- The Chronic Pain Grade questionnaire: Validation and reliability in postal research.Pain. 1997; 71: 141-147
- The comparative safety of analgesics in older adults with arthritis.Arch Intern Med. 2010; 170: 1968-1978
- Validation and utility of a self-report version of PRIME-MD: The PHQ primary care study.JAMA. 1999; 282: 1737-1744
- The Pain Catastrophizing Scale: Development and validation.Psychol Assess. 1995; 7: 524-532
- Mediators, moderators, and predictors of therapeutic change in cognitive-behavioral therapy for chronic pain.Pain. 2007; 127: 276-286
- De facto long-term opioid therapy for non-cancer pain.Clin J Pain. 2008; 24: 521-527
- Rates of opioid misuse, abuse, and addiction in chronic pain: A systematic review and data synthesis.Pain. 2015; 156: 569-576
- A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability.Pain. 1993; 52: 157-168
- A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity.Med Care. 1996; 34: 220-233
Article info
Publication history
Published online: December 17, 2016
Accepted:
December 6,
2016
Received in revised form:
November 28,
2016
Received:
July 12,
2016
Footnotes
Research reported in this article was supported by grant 034083 from the National Institute on Drug Abuse of the National Institutes of Health, and by resources from the VA Health Services Research and Development-funded Center to Improve Veteran Involvement in Care at the VA Portland Health Care System (CIN 13-404). The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the Department of Veterans Affairs or the National Institute on Drug Abuse.
Drs. Yarborough, Perrin, and Green have received grant support from Purdue Pharma LP, and the Industry PMR Consortium, a consortium of 10 companies working together to conduct U.S. Food and Drug Administration-required postmarketing studies that assess known risks related to extended-release, long-acting opioid analgesics. The remaining authors have no conflicts of interest to declare.
Identification
Copyright
Published by Elsevier Inc. on behalf of the American Pain Society
