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As per prior discussions, I have taken 99% of those non-malignant pain patients on high dose opioids down to more modest levels and stabilized at a steady dose for at least 1 month at the lower dose, and have analyzed data for 30 consecutive previously high dose patients. The measurement we use in our practice of efficacy of the opioid is "% reduction in pain from the opioid" and % of activity of daily living achievable.
Results:
Average MED prior to dosage reduction: 356mg
Average MED after dosage reduction: 117mg
Pain reduction with opioids high dosage: 54%
Pain reduction with low dosage opioids: 49%
Activity of daily living high dosage 70%
Activity of daily living low dosage 69%
These results were achieved with no other change in the practice, no increase in injections, no additional psychological interventions, no additional PT or exercise requirements.
There were 6 patients that improved their pain on dosage reduction, and 9 patients that did not change on dosage reduction. Of the remaining patients that worsened their pain reduction with opioids, the average changed from 57% to 40%. These patients had higher depression and anxiety scores than the other patients in the study.
Conclusion: in this small sample, it appears chronic pain patients do not rate their pain significantly worse when opioid dosages are reduced by 2/3 and to levels below the 120 MED threshold for increased mortality and morbidity.
Feel free to quote this data in your own practices.
Results:
Average MED prior to dosage reduction: 356mg
Average MED after dosage reduction: 117mg
Pain reduction with opioids high dosage: 54%
Pain reduction with low dosage opioids: 49%
Activity of daily living high dosage 70%
Activity of daily living low dosage 69%
These results were achieved with no other change in the practice, no increase in injections, no additional psychological interventions, no additional PT or exercise requirements.
There were 6 patients that improved their pain on dosage reduction, and 9 patients that did not change on dosage reduction. Of the remaining patients that worsened their pain reduction with opioids, the average changed from 57% to 40%. These patients had higher depression and anxiety scores than the other patients in the study.
Conclusion: in this small sample, it appears chronic pain patients do not rate their pain significantly worse when opioid dosages are reduced by 2/3 and to levels below the 120 MED threshold for increased mortality and morbidity.
Feel free to quote this data in your own practices.