title: Care management practices for chronic pain in veterans prescribed high doses of opioid medications.
abstract: BACKGROUND
  There is growing interest in the primary care management of patients with chronic non-cancer pain (CNCP) who are prescribed long-term opioid therapy.
  
  
  OBJECTIVE
  The aim of this study was to examine the care management practices and medical utilization of patients prescribed high doses of opioids relative to patients prescribed traditional doses of opioids.
  
  
  METHODS
  We conducted a retrospective cohort study of veterans who had CNCP in 2008 and reviewed medical care for the prior 2 years. Patients with CNCP who were prescribed high-dose opioid therapy (≥180mg morphine equivalent per day for 90+ consecutive days; n = 60) were compared with patients prescribed traditional dose opioid therapy (5-179mg morphine equivalent per day for 90+ consecutive days; n = 60).
  
  
  RESULTS
  Patients in the high-dose group had several aspects of documented care that differed from patients in the traditional dose group, including more medical visits, attempting an opioid taper, receiving a urine drug screen and developing a pain goal. The majority of variables that were assessed did not differ between groups, including documented assessments of functional status or co-morbid psychopathology, opioid rotation, discussion of treatment side effects, non-pharmacological treatments or collaboration with mental health or pain specialists.
  
  
  CONCLUSIONS
  Further work is needed to identify mechanisms for optimizing care management for patients with CNCP who are prescribed high doses of opioid medications.
authors.affiliation: Mental Health and Clinical Neurosciences Division and.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Morasco
authors.forename: Renee
authors.initials: R
authors.lastname: Cavanagh
authors.forename: Susan
authors.initials: S
authors.lastname: Gritzner
authors.forename: Steven K
authors.initials: SK
authors.lastname: Dobscha
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D059350:Chronic Pain / Q000188:drug therapy*; D015331:Cohort Studies; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage* / Q000009:adverse effects; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D012189:Retrospective Studies; D058014:Veterans Health
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine
keywords: Chronic pain; clinical treatment guidelines; high-dose opioids; opioids; primary care.
references.citation: Pain Med. 2011 May;12(5):740-6
references.pmid: 21481167
references.citation: J Gen Intern Med. 2006 Jun;21(6):607-12
references.pmid: 16808744
references.citation: Pain Med. 2011 Oct;12(10):1490-501
references.pmid: 21943325
references.citation: J Pain. 2012 Nov;13(11):1131-8
references.pmid: 23117108
references.citation: J Pain. 2012 Mar;13(3):266-75
references.pmid: 22285611
references.citation: J Pain. 2009 Feb;10(2):113-30
references.pmid: 19187889
references.citation: Ann Intern Med. 2010 Jan 19;152(2):85-92
references.pmid: 20083827
references.citation: J Gen Intern Med. 2011 Dec;26(12):1450-7
references.pmid: 21751058
references.citation: JAMA. 2011 Apr 6;305(13):1315-21
references.pmid: 21467284
references.citation: Pain. 2004 Dec;112(3):372-380
references.pmid: 15561393
references.citation: Arch Intern Med. 2011 Apr 11;171(7):686-91
references.pmid: 21482846
references.citation: J Gen Intern Med. 2010 Apr;25(4):310-5
references.pmid: 20049546
references.citation: Arch Intern Med. 2010 Sep 13;170(16):1425-32
references.pmid: 20837827
references.citation: J Bone Joint Surg Am. 2009 Apr;91(4):919-27
references.pmid: 19339577
references.citation: J Gen Intern Med. 2011 Sep;26(9):958-64
references.pmid: 21347877
references.citation: Pain. 2010 Dec;151(3):625-632
references.pmid: 20801580
references.citation: J Am Board Fam Med. 2011 Nov-Dec;24(6):717-27
references.pmid: 22086815
references.citation: J Gen Intern Med. 2011 Sep;26(9):965-71
references.pmid: 21562923