Higher Opioid Doses Associated with Worse Patient Outcomes

In their study of 517 patients with musculoskeletal pain who were prescribed long-term opioid therapy, researchers found significant differences in pain and quality of life among patients prescribed long-term opioid therapy.

The participants were enrolled in the Kaiser Permanente Northwest (n = 331) and VA Portland Health Care System (n = 186). Pain intensity, function, quality of life, and mental health were reported by participants, and the basis of their current opioid dose in the daily morphine equivalent dose (MED) was used to divide participants into 3 groups: low (5-20 mg MED), moderate dose (20.1-50 mg MED), and high dose (50.1-120 mg MED).
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Analysis showed a statistically significant trend between increases in opioid dose and poorer health-related outcomes. Higher prescription opioid dose was associated with moderately sized effects, including pain intensity, more impairments in functioning and quality of life, poorer self-efficacy for managing pain, greater fear avoidance, and more health care utilization.

In addition, the researchers found significant differences in rates of alcohol and substance use disorders between groups.

“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,” the researchers concluded.

—Melissa Weiss

Reference:

Morasco BJ, Yarborough BJ, Smith NX, et al. Higher prescription opioid dose is associated with worse patient-reported pain outcomes and more health care utilization. J Pain. 2017; 18(4); 437–445.