Do Higher Opioid Doses Lead To Worse Outcomes?

By: Mitch Evans

Reading Time: 2 minutes

Date: 05/05/2017

Filed Under: Research, Opioid Therapy, Pain Management, Opioid Doses

A recent study published in The Journal of Pain found that patients prescribed higher opioid doses experienced greater pain intensity, higher health care utilization, and poorer quality of life. Is this a breakthrough finding or an obvious correlation?

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Benjamin Morasco, PhD and his team at VA Portland Health Care System and the Kaiser Permanante Northwest Center for Health Research studied 517 patients receiving long-term opioid therapy to treat chronic musculoskeletal pain.

Patients in the study received a stable dose of opioid therapy for pain management for at least 90 days and were segmented according to dosage:

  • Low dose: 5-20 mg Morphine Equivalents per Day (MED)
  • Moderate dose: 20.1 - 50 mg MED
  • High dose: 50.1 - 120 mg MED

While the three groups had similar demographic characteristics, an important exception was that "high dose" group members were more likely to be receiving disability benefits.

The study found that patients in the high dose group were likely to experience a host of adverse conditions, including:

  • greater pain intensity
  • more impairments to functioning and quality of life
  • lower self-efficacy for managing pain
  • higher health care utilization

Morasco posed the question big unanswered question:

"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?"

Unfortunately, we don't know the answer to this question just yet. Fortunately, that inconclusiveness may be temporary, as  the group is continuing its research with a focus on the key question:

"What are the factors that predict who gets an increase in their prescription opioid dose?"

We look forward to following the upcoming results of Dr. Morasco and his team's ongoing work, as a valuable advance in the pursuit of evidence based pain treatment.

Join the conversation by leaving a comment below or downloading our latest eBook by AffirmHealth Chief Medical Officer, Mario Ramirez, MD:

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