High-Dosage Opioid Prescription Correlates With Depression, Increased Pain Sensitivity, and Hepatitis Diagnoses: Presented at AAFP

By Carole VanSickle Ellis

DENVER -- October 5, 2010 -- High doses of opioid medication over an extended period of time will increase patient pain sensitivity. It also indicates a set of patient characteristics (depression, hepatitis C) that can be used to predict prescription abuse, researchers reported here October 2 at the American Academy of Family Physicians (AAFP) 2010 Scientific Assembly.

Lead investigator Shannon Essler, a pre-med student at Southwestern University, Georgetown, Texas, and her fellow researchers recommended that clinicians recognise dosages of 50 mg/day or less in morphine equivalence, and reconsider prescribing opioids above 115 mg/day for chronic, non-cancer pain to minimise the risk of addiction and abuse.

The 213 patients in this study had had low back pain for 3 months or longer during 2008; they were followed up in 2009. Patients who were pregnant or had cancer were excluded from the study, leaving a subject group of 204.

The research team used medical records to compile causes for lower back pain, procedural treatment for pain, comorbidities, and body mass index (BMI), reported Essler. A survey on demographic characteristics and other patient characteristics -- including anxiety, depression, and substance abuse -- completed the process and enabled the group to divide the subjects into 3 sections: nonusers of opioid medications (n = 100), moderate users (<=115 mg morphine equivalent per day, n = 94), and high users (>115 mg per day, n = 10).

Seventy percent of the subject group was female, 40% were Hispanic, and 45% were white. The average age was 55 (range: 19-90 years). Half of the subjects used the medication to control back pain, with the average dose for moderate users being 35 mg per day.

When the 3 groups were compared, some distinct differences were apparent. Among the high users, 70% were being treated for depression, while moderate and nonusers being treated for depression measured 44.7% and 26%, respectively (P =.002). Additionally, 30% of the high users had been diagnosed with hepatitis C, with only 10.6% of moderate users and 4% of nonusers receiving this diagnosis (P =.010).

Essler noted that this study was limited by a relatively small sample of high-dose users, but added that the results were significant enough to allow the recommendation that clinicians "reconsider the appropriateness of any opioid prescribing above 115 mg/day for non-cancer pain."

Funding for this study was provided by the Texas Academy of Family Physicians, the South Texas Area Health Education Center, and the Dean's Office, School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas.

[Presentation title: Characteristics of Patients Using Extreme Opioid Dosages in the Treatment of Chronic Low Back Pain. Abstract P052]

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