(142) Outcomes of Prescription Opioid Dose Escalation for the Treatment of Chronic Pain: Results from a Prospective Cohort Study

Abstract

Long-term opioid therapy for chronic pain is common, yet data on long-term outcomes, especially after dose escalation, are sparse. We conducted a two-year cohort study to examine potential benefits and harms associated with prescription opioid dose escalation. All participants (n=517) were receiving a stable dose of long-term opioid therapy (LTOT) at baseline. They completed self-report measures of pain, function, depression, and potential adverse effects at baseline and every six months for two years. We reviewed electronic health record data weekly to identify episodes of prescription opioid dose escalation; participants who increased their dose were seen for an additional research visit within one month of dose escalation. Over the two-year period, 19.5% of participants had an increase in prescription opioid dose of 15% or more of baseline dose (average dose increase was 104%, SD=105). After controlling for covariates, there were no significant changes in pain intensity or pain interference over time, and no differences based on dose escalation status. There were also no significant changes over time in average depression severity or sleep functioning. Statistically significant improvements were found on measures of medication-related side effects and risk for prescription opioid misuse; sexual functioning significantly worsened over time. Across all outcome measures, the only variable that significantly differed based on dose escalation status was risk for prescription opioid misuse; the average score in the dose escalation group was 2.4 points lower at the end of the two-year observation window compared with the non-escalation group (p=0.018). In sum, patients who are prescribed a stable dose of LTOT demonstrate few changes in key pain-related outcomes over time, and prescription opioid dose escalation status is unrelated to most clinical outcomes.