Escalating Opioid Doses in Chronic Pain

Escalating Opioid Doses in Chronic Pain – by Judy George, Senior Staff Writer, MedPage Today – Apr 2019

This study, like 99% of the research being done, assumes opioid doses are completely independent of pain levels, making it utter nonsense to anyone who understands pain.

Increases in prescription opioid doses were unrelated to most clinical outcomes among chronic pain patients, according to a 2-year prospective cohort study.

Moreover, patients who had been prescribed a stable dose of long-term opioid therapy demonstrated few clinically significant changes in pain-related outcomes over time.   

For this study, Morasco and colleagues recruited 517 adults with a chronic musculoskeletal pain from the Kaiser Permanente Northwest and Veteran Affairs (VA) Portland health care system who were prescribed a stable dose of long-term opioid therapy.

The researchers excluded patients who

  • were receiving opioids for cancer treatment or palliative care,
  • had pending a disability claim related to a pain condition,
  • had enrolled in an opioid substitution program in the past year,
  • had a current opioid dose >120 mg, or
  • whose opioid prescriptions were solely tramadol or buprenorphine.

I have to wonder how many of the whole cohort of pain were excluded.

The average daily opioid dose at baseline was 36.2 mg morphine equivalent dose (MED).

Of the 517 participants who enrolled, 19.5% (n=101) had a prescription opioid dose increase of 15% or more from their baseline dose.

The baseline dose of these 101 patients was 27 MED;

the baseline dose of patients who didn’t have an increase (n=416) was 39 MED.

So, the patients on the lower dose needed an increase – that shouldn’t be surprising. They always use very low baseline opioid doses when they are trying to say that the opioid doses, in general, are increasing.

The average increase in prescription opioid dose from baseline was 104%.

This is worded as though the opioid dose more than doubled, and I seriously doubt that from what I can see in this abstract.

After controlling for covariates — medical comorbidities, alcohol and substance use, pain catastrophizing, pain self-efficacy, complementary and integrative treatments for chronic pain, and other factors — the researchers found no significant changes in pain intensity or pain interference over time, and no differences based on dose escalation status. Specifically:

Average pain intensity score decreased by 0.79 points a year, and there was no difference in average pain intensity based on dose increase status

Average pain interference increased by 1.42 points per year; this also showed no difference based on dose increase status.

Duh, these increases in pain would be expected as we age. Why do researchers act as though we age without the body breakdowns of physical aging?

No significant changes in depression severity or sexual functioning over time emerged, and no difference was seen based on dose increase status

On average, those in the dose increase group had higher scores on risk for prescription opioid misuse, but they also had greater average reductions in risk over time.

So it’s a wash. Nothing to see here folks.

Those in the dose increase group had poorer sleep functioning compared to those in the stable dose group on average, and there were no differences in change over time.

Again, duh. People on higher doses have higher pain levels, so none of this is unexpected (except for the ignorant anti-opioid biased researchers).

The average score for short-term medication-related side effects such as constipation, nausea, and vomiting decreased over time, and there was no difference based on dose increase status.

I luckily only suffer from the first, and though it’s managable with MiraLax, I’m happy to see that it might decrease over time.

We didn’t really see long-term improvements,” Morasco added.

Why do they always expect “improvement” when we have chronic conditions? That’s just completely unrealistic, yet they keep ignoring the fact that our pain is, by definition, a chronic life-long condition.

People may have had changes in pain intensity soon after dose escalation, but when we really follow them for up to a year after their dose escalation, we don’t see long-term changes.”

Are these researches unusually stupid? When pain increases, the opioid dose must increase to keep it manageable at the same level.

These must be young, sheltered, privileged people to have so little understanding of the obvious issues involved with chronic pain.

2 thoughts on “Escalating Opioid Doses in Chronic Pain

Other thoughts?

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.