Reuters Health News, Medlinx, February 19, 2020
According to a 2-year study, in chronic musculoskeletal pain patients, an enhancement in opioid dosage seems to be of no precise benefit. When patients with chronic pain on long-term opioid therapy were monitored, it was observed that overall patients did not undergo long-term clinically significant improvements in pain or functioning after prescription-opioid dose escalation. This outcome recommended that opioid-dose enhancement is difficult, to be an effective strategy to chronic-pain management – as reported by Dr. Benjamin J. Morasco to Reuters Health by email.
Dr. Morasco of the VA Portland Health Care System, in Oregon, and colleagues monitored 517 patients who were taking long-term opioid therapy with a stable dose at baseline. At baseline and every 6 months for 2 years, the subjects self-reported measures of pain, disability, depression, and potential adverse effects. Throughout the study, 19.5% of subjects had prescription-opioid dose escalation, the investigators report in pain. Escalation was termed as a rise in the daily morphine-equivalent dose of 15% or more from baseline persistent at minimum 56 days. No significant modifications on any variable following dose escalation was observed after controlling for covariates and only 3% of this group underwent a clinically meaningful improvement in pain. Broadly, subjects were encountered with small improvements in pain intensity, depressive symptoms and side effects and a lower risk of prescription-opioid misuse during the study period. On the other hand, sexual functioning significantly declined over time. These findings suggest an essential alteration in the approach to long-term management of pain with opioids, providing further encouragement for Centers for Disease Control and Prevention recommendations to restrict dose escalation – as concluded by the researchers.
However, Dr. Morasco also highlighted that “there are essential restrictions to the study that should be considered. Particularly, they did not randomize patients to receive opioid-dose escalation; hence, they cannot depict causal conclusions.” He also reported that – It is possible that opioid-dose enhancement might have supported people to maintain pain at their baseline level and without a dose enhancement, their pain might have escalated; the study design would not have been able to determine this.
Dr. David A. Edwards, chief of the division of pain medicine at Vanderbilt University Medical Center, in Nashville, Tennessee, reported Reuters Health by email that historically, investigation on this topic has been insufficient.
“The authors here designed a study to offer higher-quality medical evidence about the benefit of escalating opioid dose to treat chronic pain. An essential part of this study was that the patients themselves informed how they felt and how they were doing. The patients with chronic musculoskeletal pain already on moderate-dose opioids said, on average, that pain and function did not improve when opioids were escalated. Dr. Edwards reported that for people living with chronic musculoskeletal pain, like arthritis, the patients in this study are reporting that escalating opioid pain medicines does not reduce the pain or improve function. Thus, he concluded that it is essential to look for other kinds of treatments, either physical or psychological therapies, or other types of medicines not studied here.
