Lack of Correlation Between Opioid Dose Adjustment and Pain Score Change in a Group of Chronic Pain Patients

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 (MGH) 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. Perspectives 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 non-malignant pain conditions.

Opioid Use After Fracture Surgery Correlates With Pain Intensity and Satisfaction With Pain Relief

“…Consensus is increasing that opioid medication alone is not as safe and effective as once thought, and high-dose prescription or prolonged opioid therapy does not improve outcomes [12]. Patients in the United States use far more opioid analgesics than patients in other countries but do not experience less pain or greater satisfaction with pain relief [21,25,31].…”

Only Modest Long-Term Opioid Dose Escalation Occurs Over Time in Chronic Nonmalignant Pain Management

“…The data we have analyzed inform us about primary care physician behavior but not about patient experience because we have no patient reported outcomes. However, the report by Chen et al 19 suggests that patient reported outcomes including pain report might not be as useful as we would like them to be.…”

“…Chen et al 19 looked at dose adjustments in 109 patients receiving opioid pharmacotherapy for chronic nonmalignant pain with the goal of ascertaining the relationship of dose adjustments derived from first and last visits to clinical pain report scores on those visits. Neither opioid dose increases nor decreases had any effect on clinical pain scores.…”

“…Han and colleagues found that younger age but not gender significantly increased the rate of dose escalation. Chen et al 19 determined that neither age nor gender influenced the potential relationship between opioid dose adjustments and clinical pain scores. In our data, we found no relationship between either age or gender and opioid dose escalation.…”

WHO analgesic ladder: a good concept gone astray

“…With so many factors altering chronic pain as it is experienced and reported, it is not surprising that pain scores do not respond in any predictable fashion to opioids. 12 In fact, attempts to lower pain scores using opioids has led to overuse and adverse outcomes without any appreciable lowering of the chronic pain burden at the population level.…”