1. 2019;22;401-411The Social and Functional Implications of High- Versus Low-Dose Opioids on Chronic Non-Cancer Pain
   Retrospective Review
   Till Conermann, MD, Yohei Denawa, MD, and Will Kurtz, MD.

BACKGROUND: Chronic non-cancer pain (CNCP) is a major health concern. Opioids may be a useful treatment option, but their use still remains controversial given the significant risks and epidemic of opioid addiction and abuse. There is limited data on whether opioid therapy is an effective treatment option for chronic non-cancer pain.

OBJECTIVE: To assess both physical and emotional dimensions of health for patients on opioid therapy for CNCP by reviewing the 36-Item Short Form Health Survey (SF-36) .

STUDY DESIGN: This study was a retrospective cohort review.

SETTING: Outpatient pain clinic

METHODS: We recruited 182 patients at the West Penn Pain Institute outpatient pain clinic: 94 patients were recruited for the low-dose opioid group (5-30 morphine milligram equivalents [MME]) while 88 patients were recruited for the high-dose opioid group (> 90 MME). Each patient filled out the SF-36 survey used to assess both the physical and emotional dimensions of their health. We also analyzed patients’ employment status, reasons for unemployment, pain diagnosis, side effects, and compliance issues through the electronic medical record (EMR).

RESULTS: Mean scores on General Health Perceptions for the low-dose and high-dose opioid groups were 50.3 ± 21.6 and 44.4 ± 21.9, respectively (P = .07). Though not reaching statistical significance, high-dose patients had lower item scores, indicating a perception of poorer health. There were no significant differences between the low-dose and high-dose opioid treatment groups on any of the mean scores from 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 had significantly higher rates of unemployment (85%) than did low-dose opioid patients (66%) (x-squared[1] = 8.48, P =.004; odds ratio [OR] = 2.89 [95% confidence interval (CI), 1.39-6.01]). Unemployed patients in the high-dose treatment group were more likely to list disability as unemployment while retirement was the most common response in the low-dose treatment group. Patients treated with high-dose opioids had significantly higher rates of self-reported side effects (46%) than did low-dose opioid patients (21%) (x-squared[1] = 12.02, P =.001; OR = 3.08 [95% CI, 1.61-5.89]). Patients treated with high-dose opioids had significantly higher rates of noncompliance (49%) than did low-dose opioid patients (33%) (x-squared[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 than the odds for a low-dose opioid patient; the odds of a high-dose opioid patient self-reporting side-effects were 3.08 times greater than the odds for a low-dose opioid patient; and the odds of a high-dose opioid patient being noncompliant with their medications were 1.94 times greater than the odds for a low-dose opioid patient.

LIMITATIONS: The observation al design prohibits drawing causal relationships, and entry criteria was restricted.

CONCLUSIONS: These data suggest that patients receiving low-dose and high-dose opioid treatment do not have significantly different quality-of-life outcomes. Future studies that incorporate longitudinal data are 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