Predictors of opioid efficacy in patients with chronic pain: A prospective multicenter observational cohort study.
Opioids are increasingly used for treatment of chronic pain. However, they are only effective in a subset of patients and have multiple side effects. Thus, studies using biomarkers for response are highly warranted. The current study prospectively examined 63 opioid-naïve patients initiating opioid use for diverse types of chronic pain at five European centers. Quantitative sensory testing, electroencephalography (EEG) recordings, and assessment of pain catastrophizing were performed prior to treatment. The co-primary outcomes were change from baseline in ratings of chronic pain and quality of life after 14 days of opioid treatment. Secondary outcomes included patient's global impression of clinical change and side effects. Logistic regression models adjusted for age and sex were used to identify biomarkers predictive for successful treatment, defined as at least a 30% reduction in average pain intensity or an improvement in quality of life of at least 10 scale points. Fifty-nine patients (94%) completed the study. The mean age was 55 ± 16 years and 69% were females. Pain reduction was predicted by cold pain intensity (OR: 0.69; P = 0.01), pain catastrophizing (OR: 0.82; P = 0.03), relative delta (OR: 0.76; P = 0.03) and beta EEG activity (OR: 1.18; P = 0.04) induced by experimental cold pain. None of the study variables were related to improvement in quality of life. For the first time, individual pain processing characteristics have been linked to opioid response in a mixed chronic pain population. This has the potential to personalize treatment of chronic pain and restrict opioid use to patients with high likelihood for response.
Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark.|Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Kasper
http://orcid.org/0000-0002-2147-899X
K
Grosen
Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark.|Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.|Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Anne E
AE
Olesen
Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark.
Mikkel
M
Gram
Valdemar Hospital, Ringsted, Denmark.
Torsten
T
Jonsson
Valdemar Hospital, Ringsted, Denmark.
Michael
M
Kamp-Jensen
Friklinikken, Region of Southern Denmark, Give, Denmark.
Trine
T
Andresen
Friklinikken, Region of Southern Denmark, Give, Denmark.
Christian
C
Nielsen
Department of Anaesthetics and Surgical Intensive Care, Ljubljana University Medical Centre, Ljubljana, Slovenia.
Gorazd
G
Pozlep
Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.
Mogens
M
Pfeiffer-Jensen
Leuven Centre for Algology & Pain Management, University Hospitals Leuven, University Hospitals Leuven, Pellenberg, Belgium.
Bart
B
Morlion
Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark.|Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Asbjørn M
AM
Drewes
D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D059350:Chronic Pain / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome
D000701:Analgesics, Opioid