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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


Checked for plagiarism Yes

Review by Single anonymous peer review

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

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