Reduction in Opioids: Impact on Pain and Function in a Private Practice

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Aether2000

algosdoc
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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.

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Only 117mg more to go! :)

Thanks for the study. I'd really like to know at what MED level the pain begins to rise. I suspect the pain level graph would remain quite flat to all the way to zero mg.
 
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Is it pain we are treating? Or is this just office based MAT?

J Subst Abuse Treat. 2014 Aug;47(2):140-5. doi: 10.1016/j.jsat.2014.03.004. Epub 2014 Apr 4.
Reasons for opioid use among patients with dependence on prescription opioids: the role of chronic pain.
Weiss RD1, Potter JS2, Griffin ML3, McHugh RK3, Haller D4, Jacobs P5, Gardin J 2nd6, Fischer D7, Rosen KD8.
Author information

Abstract
The number of individuals seeking treatment for prescription opioid dependence has increased dramatically, fostering a need for research on this population. The aim of this study was to examine reasons for prescription opioid use among 653 participants with and without chronic pain, enrolled in the Prescription Opioid Addiction Treatment Study, a randomized controlled trial of treatment for prescription opioid dependence. Participants identified initial and current reasons for opioid use. Participants with chronic pain were more likely to report pain as their primary initial reason for use; avoiding withdrawal was rated as the most important reason for current use in both groups. Participants with chronic pain rated using opioids to cope with physical pain as more important, and using opioids in response to social interactions and craving as less important, than those without chronic pain. Results highlight the importance of physical pain as a reason for opioid use among patients with chronic pain.
 
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