We compared group differences on the basis of prescription opioid dose.
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Higher opioid dose was associated with poorer pain outcomes and more health care utilization.
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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
Musculoskeletal pain
opioids
chronic pain
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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.
Published by Elsevier Inc. on behalf of the American Pain Society