Patients report worse outcomes with higher opioid dosages - Study

Patients report worse outcomes with higher opioid dosages - Study

If you’ve been taking opioids for pain and found things getting worse the more you took instead of better, you’re not alone. A large study by researchers at the VA and Kaiser Permanente found that increases in frequency and dosage are associated with worse patient-reported outcomes – more pain and more dysfunction. “One of the things that makes this current study unique is that it’s the first to identify more impairment, and higher pain based on opioid dose, when using question and answer survey instruments,” lead researcher Benjamin Morasco, PhD, told Pain Medicine News (PMN). Most earlier opioid use studies used medical records, which don’t tell you much about what a patient is really experiencing. The problem is that the study’s methodology couldn’t ascertain whether increased pain and dysfunction were caused by higher doses of opioids, or whether patients were just getting more opioids because their painful conditions were worsening. A new study to answer these questions is being planned. For the current study, a large group of 500-plus patients answered batteries of questions about their mental, emotional and physical health conditions and uses of other substances as well as their experience with prescription opioid painkillers.

Long-term opioid therapy for chronic pain

All patients were suffering from chronic musculoskeletal pain, and being treated with opioids long-term – at least 90 consecutive days. They were divided into three groups based on dose level for study analysis – lower doses, medium dosage and higher doses. Dr. Morasco and colleagues found that patients in the higher-dose group reported 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, PMN reported. Also, the low-dose group scored lowest for potential substance use disorder, while the higher-dose patients scored highest. For decades, doctors have known about and warned patients about “opioid induced hyperalgesia” – becoming more sensitive to painful stimuli because of the opioid painkillers. The more opioids you consume, the more painkiller you might feel you need. Hyperalgesia is a possible side-effect of opioid painkillers. It can set off a deadly cycle of increasing consumption that can lead rapidly to dependence and even addiction. Patients chase after what they feel is very real pain – and in fact it is real - with more and more opioids. The question of whether high opioid doses are contributing to or reflecting the requirements of more pain and dysfunction is of prime concern to the researchers. “Are people that are trying high doses finding those lead to more impairment, and more problems, and more adverse effects, or do people that have more pain and lower quality of life—are they more likely to get higher doses of opioids?” Dr. Morasco asked. “The answer is, unfortunately, that we don’t know, and the results of the study don’t inform that question.” The group says it’s planning a larger study soon that will examine more closely the circumstances affecting the decisions to increase opioid dosages.

Meanwhile, Novus recently reported on another recent study showing that opioid induced hyperalgesia doesn’t require long-term opioid use – it can start happening right away. Best advice is to always first look for alternative pain treatments before resorting to opioids. And if you or someone you care for is already in the grip of opioids, call Novus right away.

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