Dose Escalation During the First Year of Long‐Term Opioid Therapy for Chronic Pain. Issue 4 (19th December 2014)

• Record Type: Journal Article
• Authors: Henry, Stephen G.; Wilsey, Barth L.; Melnikow, Joy; Iosif, Ana‐Maria
• Is Part Of: Pain medicine. Volume 16:Issue 4(2015)
• Page Start: 733
• Page End: 744
• Publication Date: 2014-12-19
• Subjects: Pain -- Periodicals; Pain -- Treatment -- Periodicals; Analgesics -- Periodicals; Pain -- Periodicals; Pain Management -- Periodicals; Douleur -- Périodiques; Douleur -- Traitement -- Périodiques; Analgésiques -- Périodiques; Analgésique; Soulagement de la douleur; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.047205
• DOI: 10.1111/pme.12634
• Languages: English
• ISSNs: 1526-2375

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="pme12634-sec-0001" sec-type="section"> <title>Objective</title> <p>To identify patient factors and health care utilization patterns associated with dose escalation during the first year of long‐term opioid therapy for chronic pain.</p> </sec> <sec id="pme12634-sec-0002" sec-type="section"> <title>Design</title> <p>Retrospective cohort study using electronic health record data.</p> </sec> <sec id="pme12634-sec-0003" sec-type="section"> <title>Setting</title> <p>University health system.</p> </sec> <sec id="pme12634-sec-0004" sec-type="section"> <title>Subjects</title> <p>Opioid naïve adults with musculoskeletal pain who received a new outpatient opioid prescription between July 1, 2011 and June 30, 2012 and stayed on opioids for 1 year.</p> </sec> <sec id="pme12634-sec-0005" sec-type="section"> <title>Methods</title> <p>Mixed‐effects regression was used to estimate patients' rate of opioid dose escalation. Demographics, clinical characteristics, and health care utilization for patients with and without dose escalation were compared.</p> </sec> <sec id="pme12634-sec-0006" sec-type="section"> <title>Results</title> <p>Twenty‐three (9%) of 246 patients in the final cohort experienced dose escalation (defined as an increase in mean daily opioid dose of ≥30‐mg morphine equivalents over 1 year). Compared with patients without dose escalation, patients with escalation had higher rates of substance use diagnoses (17% vs 1%, <italic>P</italic> = 0.01) and more total outpatient encounters (51 vs 35, <italic>P</italic> = 0.002) over 1 year. Differences in outpatient encounters were largely due to more non face‐to‐face encounters (e.g., telephone calls, emails) among patients with dose escalation. Differences in age, race, concurrent benzodiazepine use, and mental health diagnoses between patients with and without dose escalation were not statistically significant. Primary care clinicians prescribed 89% of opioid prescriptions.</p> </sec> <sec id="pme12634-sec-0007" sec-type="section"> <title>Conclusions</title> <p>Dose escalation during the first year of long‐term opioid therapy is associated with higher rates of substance use disorders and more frequent outpatient encounters, especially non face‐to‐face encounters.</p> </sec> </abstract>