Higher Opioid Doses Do Not Lessen Pain, But Increase Overdose Risks: Studies

New research suggests that increasing the prescribed dose of opioids for treatment of chronic pain does not have any significant therapeutic benefit, but is associated with an increased risk of opioid-related adverse health problems, such as increased pain sensitivity and risk of substance use disorder.

Two studies recently published online in the scientific journals Pain and Addiction reviewed chronic pain patient records, to determine whether increasing opioid intake to decrease pain was an effective practice, and if it was consequently associated with any adverse health effects.

Researchers from Central Arkansas and Minneapolis VA health care systems analyzed prescribing data for more than 50,000 Veterans Affairs patients taking opioids from 2008 through 2015, and found patients who had their opioid doses increased did not have a significant or meaningful improvement in pain management, compared to those who continued the same dose.

During the study time frame, 21,000 patients being treated for arthritis, back pain, neck pain, neuropathic pain, or migraines had their opioid dose escalated between 20% and 60% as a means to decrease their chronic pain.

When patients rated their pain on the Numeric Rating Scale during routine clinical encounters, researchers found dose escalation among patients with chronic pain was not associated with improvements in pain scores. Researchers further identified that patients who maintained their opioid dosage reported a pain decrease average of 0.3, compared to those who had increased opioid doses reporting a decreased pain average of .01.

Increasing the individual’s opioids dose was found to have caused them to experience increased pain sensitivity, which is one of the side effects of pain medications, according to the team of researchers.

Researchers then compared the two groups on whether dose escalation also increased patients’ risk of adverse effects such as suicide attempts, fall accidents and substance use disorders.

Several adverse health consequences were noted in this comparison. The researchers found the increase in opioid dosing increased the risk for patients developing substance abuse disorders by 30% for all substances, and by 50% for solely opioid abuse.

Synthetic opioids, such as fentanyl, are primarily responsible for the increase in deaths and account for many of the annual overdoses. The U.S. Centers for Disease Control and Prevention (CDC) reported drug overdose deaths from 2013 to 2017 and found nearly 64,000 overdose deaths in the U.S. in 2016 were linked to opioids, which is a 21% increase from 2015.

The opioid abuse and overdose crisis has reached epic proportions with previous studies finding opioid deaths now outnumber breast cancer fatalities and the problem is only worsening. Opioids now account for 70% of all drug overdose deaths, often prescribed by doctors without a documented pain diagnosis or reason.

Some research indicates doctor prescribing habits are largely to blame. Especially considering half of all patients don’t actually need opioids to help control their pain, according to a JAMA Surgery study.