Functional and Physiologic Correlates of Opioid Reduction in a Chronic Pain Population with Control Cohort: Cause for Concern? 8250

Abstract

Objectives

To investigate the functional and physiological effects of opioid dose reduction in a chronic pain population as compared with those who remained on a stable dose regimen.

Design

Opioid dose reduction was offered to all prescribed opiates for chronic pain therapy, and provided for those agreeing to participation concurrent to those choosing not to do so while rigorously monitoring functional and physiologic outcomes of both groups in a similar fashion. The patients in the interventional group voluntarily had opioid reduction as tolerated of approximately 5% every other month, whereas control patients continued on their same regimen. Outcomes monitored over several years included prescribed average morphine mg dose equivalents (MME), blood pressure, strength, weight, and cognitive function, as well as self-reported Epworth sleepiness, sleep, work, and exercise hours, pain, nausea, constipation, pain disability index, and suicidality levels. Group outcomes were evaluated statistically using multivariate analysis of variance.

Setting

Outpatient specialty clinic.

Participants

Dose-stable chronic pain patients prescribed opiates agreeable to voluntary dose reduction (intervention group, n=103; baseline MME, 174mg/d), versus no dose reduction (control, 118; baseline MME, 144mg/d).

Interventions

Five percent reduction of prescribed medication doses approximately every other month as tolerated.

Main Outcome Measures

Prescribed average MME, self-reported sleep, exercise, and work hours, Epworth Sleepiness scale, nausea, constipation, pain, anxiety (GAD7), depression (Patient Health Questionnaire-9 Scale), and suicidality (SBQ-R) levels, as well as pain disability index ratings, average blood pressures, body mass index, grip strengths, and Trails Making Test performances.

Results

Thirty-seven decreased MME was demonstrated in opioid reduction group (vs no change among controls: P=.002), as well as lesser (P>.05) improvements in Epworth sleepiness and Pain Disability Index scores. However, there was also a significant decrease in overall exercise among the reduction participants (P=.004) not seen among controls, as well as several nonsignificant changes including decreased sleep, increased constipation, nausea, slower cognitive function, and increased suicidality scores among dose reduction participants compared with the others. Pain increased slightly in all.

Conclusions

Opioid dose reduction was significant in this previously stable-dose volunteer cohort, who also demonstrated a significant decrease in exercise participation. There were also nonsignificant trends of less sleep, more constipation and nausea, slower cognitive function and increased suicidality despite improved pain disability index reporting among participants reducing opiate dosage when compared with those maintained on a steady dose regimen suggesting that additional study and careful monitoring are warranted during opioid dose reduction efforts.

Disclosures

none.