The Social and Functional Implications of High- Versus Low-Dose Opioids on Chronic Non-Cancer Pain

Background: Chronic non-cancer pain (CNCP) is a major health concern. Opioids may be a usefultreatment option, but their use still remains controversial given the significant risks and epidemic ofopioid addiction and abuse. There is limited data on whether opioid therapy is an effective treatmentoption for chronic non-cancer pain.Objective: To assess both physical and emotional dimensions of health for patients on opioid therapyfor CNCP by reviewing the 36-Item Short Form Health Survey (SF-36) .Study Design: This study was a retrospective cohort review.Setting: Outpatient pain clinicMethods: We recruited 182 patients at the West Penn Pain Institute outpatient pain clinic: 94 patientswere recruited for the low-dose opioid group (5-30 morphine milligram equivalents [MME]) while 88patients were recruited for the high-dose opioid group (> 90 MME). Each patient filled out the SF-36survey used to assess both the physical and emotional dimensions of their health. We also analyzedpatients’ employment status, reasons for unemployment, pain diagnosis, side effects, and complianceissues through the electronic medical record (EMR).Results: Mean scores on General Health Perceptions for the low-dose and high-dose opioid groups were50.3 ± 21.6 and 44.4 ± 21.9, respectively (P = .07). Though not reaching statistical significance, highdose patients had lower item scores, indicating a perception of poorer health. There were no significantdifferences between the low-dose and high-dose opioid treatment groups on any of the mean scoresfrom the 8 domains of the SF-36.There was a statistically significant association between opioid treatment group and working status,noncompliance, and the self-reported number of side effects. Patients treated with high-dose opioids hadsignificantly higher rates of unemployment (85%) than did low-dose opioid patients (66%) (χ2[1] = 8.48, P=.004; odds ratio [OR] = 2.89 [95% confidence interval (CI), 1.39-6.01]). Unemployed patients in the highdose treatment group were more likely to list disability as unemployment while retirement was the mostcommon response in the low-dose treatment group. Patients treated with high-dose opioids had significantlyhigher rates of self-reported side effects (46%) than did low-dose opioid patients (21%) (χ2[1] = 12.02, P=.001; OR = 3.08 [95% CI, 1.61-5.89]). Patients treated with high-dose opioids had significantly higher ratesof noncompliance (49%) than did low-dose opioid patients (33%) (χ2[1] = 4.75, P =.029; OR = 1.94 [95%CI, 1.07-3.54]). Thus, the odds of a high-dose opioid patient being unemployed were 2.89 times greater thanthe odds for a low-dose opioid patient; the odds of a high-dose opioid patient self-reporting side-effects were3.08 times greater than the odds for a low-dose opioid patient; and the odds of a high-dose opioid patientbeing noncompliant with their medications were 1.94 times greater than the odds for a low-dose opioidpatient.Limitations: The observation al design prohibits drawing causal relationships, and entry criteria wasrestricted.Conclusions: These data suggest that patients receiving low-dose and high-dose opioid treatment donot have significantly different quality-of-life outcomes. Future studies that incorporate longitudinal dataare necessary to examine the temporal relationship between quality of life and opioid therapy.Key words: Chronic pain, chronic non-cancer pain, opioids, pain, quality of life, side effects,noncompliance, unemployment