Back to Journals » Journal of Pain Research » Volume 11

Impact of opioid dose reduction on individuals with chronic pain: results of an online survey

Authors Twillman RK, Hemmenway N, Passik SD, Thompson CA, Shrum M, DeGeorge MK

Received 26 May 2018

Accepted for publication 9 August 2018

Published 8 November 2018 Volume 2018:11 Pages 2769—2779

DOI https://doi.org/10.2147/JPR.S175402

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 4

Editor who approved publication: Dr E Alfonso Romero-Sandoval


Robert K Twillman,1,2 Nicole Hemmenway,3 Steven D Passik,4 Christy A Thompson,4 Michael Shrum,4 Michael K DeGeorge4

1Academy of Integrative Pain Management, Lenexa, KS, USA; 2Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine, Kansas City, KS, USA; 3US Pain Foundation, Middletown, CT, USA; 4Collegium Pharmaceutical Inc., Canton, MA, USA

Background: In 2016, the Centers for Disease Control and Prevention (CDC) released a guideline on opioid prescribing for primary care physicians. Patients with chronic pain receiving long-term opioid therapy were surveyed to assess the incidence and impact of opioid dose reduction following this guideline’s promulgation.
Methods: Members of an advocacy organization for people with chronic pain were invited to participate in a 16-item, anonymous, online survey conducted in September/October 2017. Eligibility requirements included current treatment of ≥7 months’ duration for chronic pain with the same extended-release (ER)/long-acting (LA) opioid. The final sample consisted of respondents who reported being on the same ER/LA opioid for ≥1 year and excluded respondents whose 1) ER/LA opioid dose increased; 2) ER/LA opioid dose decreased and immediate-release (IR) opioid dose increased; and 3) ER/LA opioid dose was unchanged and IR opioid dose was changed. Survey results were analyzed using z-test to ascertain differences between proportion of responses for ER/LA opioid dose decreased vs dose unchanged groups.
Results: Of the 511 eligible respondents, 362 respondents were included in the final sample. In the final sample, the subgroup with decreased ER/LA opioid dose (n=149) was significantly more likely (P≤ 0.05) than those who reported no dose change (n=213) to rate their condition as “worse” for level of pain (73.2 vs 33.3%), level of function (67.8 vs 31.5%), mental health (64.4  vs 32.9%), ability to work (62.9% of 97 respondents vs 33.8% of 145 respondents), and interpersonal relationships (48.3 vs 25.8%) during the previous 6 months.
Conclusion: In this Internet-based survey of people with chronic pain, reduction of ER/LA opioid dose was associated with reduced pain control and diminished function. These results indicate a need for further guidance on how to apply the CDC guideline to patients with chronic pain who are stable on long-term opioid therapy.

Keywords: CDC guideline, chronic pain, long-term opioid therapy, survey

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]