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. 2013 Apr;14(4):384-92.
doi: 10.1016/j.jpain.2012.12.012. Epub 2013 Feb 26.

Lack of correlation between opioid dose adjustment and pain score change in a group of chronic pain patients

Lucy Chen  1 , Trang Vo, Lindsey Seefeld, Charlene Malarick, Mary Houghton, Shihab Ahmed, Yi Zhang, Abigail Cohen, Cynthia Retamozo, Kristen St Hilaire, Vivian Zhang, Jianren Mao
Affiliations

Lack of correlation between opioid dose adjustment and pain score change in a group of chronic pain patients

Lucy Chen et al. J Pain. 2013 Apr.

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.

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Conflict of interest statement

Disclosure: The authors claim no conflict of interest related to this study.

Figures

Figure 1
Figure 1
Illustration of each individual subject with opioid dose increase and the corresponding clinical pain score point change. MED: daily morphine equivalent dose.
Figure 2
Figure 2
Illustration of each individual subject with opioid dose decrease and the corresponding point change in clinical pain score.
Figure 3
Figure 3
Illustration of all subjects with neuropathic pain, showing the relationship between changes in opioid dose and point change in clinical pain score.
Figure 4
Figure 4
Illustration of all subjects with nociceptive pain, showing the relationship between changes in opioid dose and point change in clinical pain score.
Figure 5
Figure 5
Illustration of all subjects with mixed pain conditions, showing the relationship between changes in opioid dose and clinical pain score.
Figure 6
Figure 6
Influence of age and gender on the relationship between opioid dose adjustment and point change in clinical pain score.
See this image and copyright information in PMC

References

    1. Ballantyne JC, Mao J. Opioid therapy for chronic pain. N Engl J Med. 2003;349:1943–1953. - PubMed
    1. Ballantyne JC, Shin NS. Efficacy of opioids for chronic pain: a review of the evidence. Clin J Pain. 2008;24:469–478. - PubMed
    1. Buntin-Mushock C, Phillip L, Moriyama K, Palmer PP. Age-dependent opioid escalation in chronic pain patients. Anesth Analg. 2005;100:1740–1745. - PubMed
    1. Cepeda MS, Etropolski M, Weinstein R, Fife D, Boston R, Matcho A. Dose patterns in commercially insured subjects chronically exposed to opioids: a large cohort study in the United States. BMC Palliat Care. 2010;9:14. - PMC - PubMed
    1. Chapman CR, Lipschitz DL, Angst MS, Chou R, Denisco RC, Donaldson GW, Fine PG, Foley KM, Gallagher RM, Gilson AM, Haddox JD, Horn SD, Inturrisi CE, Jick SS, Lipman AG, Loeser JD, Noble M, Porter L, Rowbotham MC, Schoelles KM, Turk DC, Volinn E, Von Korff MR, Webster LR, Weisner CM. Opioid pharmacotherapy for chronic non-cancer pain in the United States: a research guideline for developing an evidence-base. J Pain. 2010;11:807–829. - PubMed

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