title: Lack of correlation between opioid dose adjustment and pain score change in a group of chronic pain patients.
abstract: Despite the increasing use of opioid analgesics for chronic pain management, it is unclear whether opioid dose escalation leads to better pain relief during chronic opioid therapy. In this study, we retrospectively analyzed clinical data collected from the Massachusetts General Hospital Center for Pain Medicine over a 7-year period. We examined 1) the impact of opioid dose adjustment (increase or decrease) on clinical pain score; 2) gender and age differences in response to opioid therapy; and 3) the influence of clinical pain conditions on the opioid analgesic efficacy. A total of 109 subjects met the criteria for data collection. We found that neither opioid dose increase, nor decrease, correlated with point changes in clinical pain score in a subset of chronic pain patients over a prolonged course of opioid therapy (an average of 704 days). This lack of correlation was consistent regardless of the type of chronic pain including neuropathic, nociceptive, or mixed pain conditions. Neither gender nor age differences showed a significant influence on the clinical response to opioid therapy in these subjects. These results suggest that dose adjustment during opioid therapy may not necessarily alter long-term clinical pain score in a group of chronic pain patients and that individualized opioid therapy based on the clinical effectiveness should be considered to optimize the treatment outcome.
  
  
  CONCLUSIONS
  The study reports a relationship, or lack thereof, between opioid dose change and clinical pain score in a group of chronic pain patients. The study also calls for further investigation into the effectiveness of opioid therapy in the management of chronic nonmalignant pain conditions.
authors: Massachusetts General Hospital Center for Translational Pain Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. llchen@partners.org
authors: Lucy
authors: L
authors: Chen
authors: Trang
authors: T
authors: Vo
authors: Lindsey
authors: L
authors: Seefeld
authors: Charlene
authors: C
authors: Malarick
authors: Mary
authors: M
authors: Houghton
authors: Shihab
authors: S
authors: Ahmed
authors: Yi
authors: Y
authors: Zhang
authors: Abigail
authors: A
authors: Cohen
authors: Cynthia
authors: C
authors: Retamozo
authors: Kristen
authors: K
authors: St Hilaire
authors: Vivian
authors: V
authors: Zhang
authors: Jianren
authors: J
authors: Mao
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage*; D059350:Chronic Pain / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057285:Precision Medicine; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid