The use of long-term opioid therapy for chronic non-cancer pain (CNCP) has increased dramatically in recent years. Although chronic opioid therapy is increasingly common, there are marked differences among patients in treatment outcomes. Providers often increase opioid dose during times of worsening pain, which has the potential to decrease pain intensity, but may increase risk of medication-related adverse effects or opioid misuse. Further, side effects of opioid medications may be dose-dependent. This research will identify clinical factors that predict which patients will have increases in opioid doses. Further, we will examine the benefits and harms of opioid dose escalation and predict which patients are most likely to benefit from this intervention. This multi-site prospective cohort study will includ 600 patients with chronic pain who are currently prescribed opioids. Patients will be evaluated at baseline and every six months for 24 total months. Patients who have an increase in opioid dose (preliminary data indicates 30-35% of the sample) will be evaluated within 1 month of their dose increase and continue with regular six month follow-ups.
The Specific Aims of this proposal are to: (1) Evaluate which patient and clinician factors predict opioid dose increases, (2) Determine the differences in trajectories of pain outcomes and adverse effects between patients with and without opioid dose increases, and (3) Assess factors associated with changes in pain intensity and pain-related function over time after controlling for dose changes. We will determine the degree to which patients with opioid dose increases have sustained improvement in pain intensity and function, as well as problems with opioid misuse behaviors and medication-related adverse effects. We also hypothesize that baseline measures of fear avoidance, pain catastrophizing, and self-efficacy will predict which patients benefit from increases in opioid dose. This research has broad implications for clinical care, providing novel data to identify those patients most likely to have increases in their opioid doses, clinician and institutional factors associated with opioid dose increases, the likelihood of positive and negativ outcomes from dose increases (including prescription opioid misuse), and identification of patient factors indicating greatest likelihood of benefit from dose increases. The long-term goal of this research is to improve the treatment of chronic pain by examining the utility of increasing opioid doses in terms of changes in function and potential harms.

Public Health Relevance

Data are needed regarding the effectiveness and safety of using opioid medications to treat chronic non- cancer pain, as well as a better understanding of the impact of opioid dose escalations. This study will clarify which patients are most likely to receive dose increases for chronic pain, and detail the benefits and harms associated with dose increases. The findings have the potential to markedly improve care for patients with chronic pain and reduce the likelihood of prescription opioid misuse and medication-related adverse effects.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
4R01DA034083-04
Application #
9039572
Study Section
Behavioral Medicine, Interventions and Outcomes Study Section (BMIO)
Program Officer
Thomas, David A
Project Start
2013-04-01
Project End
2018-03-31
Budget Start
2016-04-01
Budget End
2017-03-31
Support Year
4
Fiscal Year
2016
Total Cost
Indirect Cost
Name
Oregon Health and Science University
Department
Psychiatry
Type
Schools of Medicine
DUNS #
096997515
City
Portland
State
OR
Country
United States
Zip Code
97239
Dash, Genevieve F; Wilson, Anna C; Morasco, Benjamin J et al. (2018) A Model of the Intersection of Pain and Opioid Misuse in Children and Adolescents. Clin Psychol Sci 6:629-646
Adams, Melissa H; Dobscha, Steven K; Smith, Ning X et al. (2018) Prevalence and Correlates of Low Pain Interference Among Patients With High Pain Intensity Who Are Prescribed Long-Term Opioid Therapy. J Pain 19:1074-1081
Nugent, Shannon M; Yarborough, Bobbi Jo; Smith, Ning X et al. (2018) Patterns and correlates of medical cannabis use for pain among patients prescribed long-term opioid therapy. Gen Hosp Psychiatry 50:104-110
Morasco, Benjamin J; Yarborough, Bobbi Jo; Smith, Ning X et al. (2017) Higher Prescription Opioid Dose is Associated With Worse Patient-Reported Pain Outcomes and More Health Care Utilization. J Pain 18:437-445
Morasco, Benjamin J; Krebs, Erin E; Cavanagh, Renee et al. (2015) Treatment changes following aberrant urine drug test results for patients prescribed chronic opioid therapy. J Opioid Manag 11:45-51
Adams, Melissa H; Lovejoy, Travis I; Turk, Dennis C et al. (2015) Pain-related anxiety mediates the relationship between depressive symptoms and pain interference in veterans with hepatitis C. Gen Hosp Psychiatry 37:533-7
Morasco, Benjamin J; Turk, Dennis C; Nicolaidis, Christina (2015) Psychometric Properties of the Centrality of Pain Scale. J Pain 16:676-81
Morasco, Benjamin J; O'Hearn, Daniel; Turk, Dennis C et al. (2014) Associations between prescription opioid use and sleep impairment among veterans with chronic pain. Pain Med 15:1902-10
Morasco, Benjamin J; Lovejoy, Travis I; Turk, Dennis C et al. (2014) Biopsychosocial factors associated with pain in veterans with the hepatitis C virus. J Behav Med 37:902-11