title: Higher Prescription Opioid Dose is Associated With Worse Patient-Reported Pain Outcomes and More Health Care Utilization.
abstract: Some previous research has examined pain-related variables on the basis of prescription opioid dose, but data from studies involving patient-reported outcomes have been limited. This study examined the relationships between prescription opioid dose and self-reported pain intensity, function, quality of life, and mental health. Participants were recruited from 2 large integrated health systems, Kaiser Permanente Northwest (n = 331) and VA Portland Health Care System (n = 186). To be included, participants had to have musculoskeletal pain diagnoses and be receiving stable doses of long-term opioid therapy. We divided participants into 3 groups on the basis of current prescription opioid dose in daily morphine equivalent dose (MED): low dose (5-20 mg MED), moderate dose (20.1-50 mg MED), and higher dose (50.1-120 mg MED) groups. A statistically significant trend emerged where higher prescription opioid dose was associated with moderately sized effects including greater pain intensity, more impairments in functioning and quality of life, poorer self-efficacy for managing pain, greater fear avoidance, and more health care utilization. Rates of potential alcohol and substance use disorders also differed among groups. Findings from this evaluation reveal significant differences in pain-related and substance-related factors on the basis of prescription opioid dose.
  
  
  
  This study included 517 patients who were prescribed long-term opioid therapy and compared differences on pain- and mental health-related variables on the basis of prescription opioid dose. Findings reveal small- to medium-sized differences on pain-related variables, alcohol and substance use, and health care utilization on the basis of the dose of opioid prescribed.
authors.affiliation: Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon; Department of Psychiatry, Oregon Health & Science University, Portland, Oregon. Electronic address: benjamin.morasco@va.gov.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Morasco
authors.affiliation: Kaiser Permanente Northwest Center for Health Research, Portland, Oregon.
authors.forename: Bobbi Jo
authors.initials: BJ
authors.lastname: Yarborough
authors.affiliation: Kaiser Permanente Northwest Center for Health Research, Portland, Oregon.
authors.forename: Ning X
authors.initials: NX
authors.lastname: Smith
authors.affiliation: Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon; Department of Psychiatry, Oregon Health & Science University, Portland, Oregon.
authors.forename: Steven K
authors.initials: SK
authors.lastname: Dobscha
authors.affiliation: Kaiser Permanente Northwest Center for Health Research, Portland, Oregon; Departments of Family Medicine, Internal Medicine, and the Oregon Institute for Occupational Health Sciences, Oregon Health & Science University, Portland, Oregon; Public Health and Preventive Medicine, Oregon Health & Science University, Portland, Oregon.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Deyo
authors.affiliation: Kaiser Permanente Northwest Center for Health Research, Portland, Oregon; Public Health and Preventive Medicine, Oregon Health & Science University, Portland, Oregon.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Perrin
authors.affiliation: Kaiser Permanente Northwest Center for Health Research, Portland, Oregon; Public Health and Preventive Medicine, Oregon Health & Science University, Portland, Oregon.
authors.forename: Carla A
authors.initials: CA
authors.lastname: Green
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects*; D058443:Catastrophization / Q000523:psychology; D059350:Chronic Pain / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D016208:Databases, Factual / Q000706:statistics & numerical data; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health / Q000706:statistics & numerical data; D008875:Middle Aged; D059408:Pain Management; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D055553:Prescription Drugs / Q000009:adverse effects*; D011594:Psychometrics; D011788:Quality of Life; D057566:Self Report; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy
chemical_list: D000701:Analgesics, Opioid; D055553:Prescription Drugs
keywords: Musculoskeletal pain; chronic pain; opioids