Asociación de los niveles de consumo de opioides con el dolor y su interferencia en las actividades cotidianas entre los  pacientes que inician la terapia crónica con opioides: un estudio longitudinal.: Publicado originalmente en Pain 2016;157(4):849-57. Traductor: Dr. Pablo Pino-Lozano

Judith A. Turner; Susan M. Shortreed; Kathleen W. Saunders; Linda LeResche; Michael Von Korff

doi:10.47924/neurotarget2017156

Authors

Judith A. Turner Departamento de Psiquiatría y Ciencias del Comportamiento, Universidad de Washington, Seattle, WA, USA.
Susan M. Shortreed Instituto de Investigación de Salud Grupal, Seattle, WA, USA. Departamento de Bioestadística, Universidad de Washington, Seattle, WA, USA.
Kathleen W. Saunders Instituto de Investigación de Salud Grupal, Seattle, WA, USA.
Linda LeResche Departamento de Medicina Oral, Universidad de Washington, Seattle, WA, USA.
Michael Von Korff Instituto de Investigación de Salud Grupal, Seattle, WA, USA.

DOI:

https://doi.org/10.47924/neurotarget2017156

Keywords:

opioid, chronic opioid therapy, dose, chronic pain, outcomes, activity interference

Abstract

Little is known about long-term pain and function outcomes among patients with chronic noncancer pain initiating chronic opioid therapy (COT). In the Middle-Aged/Seniors Chronic Opioid Therapy study of patients identified through electronic pharmacy records as initiating COT for chronic noncancer pain, we examined the relationships between level of opioid use (over the 120 days before outcome assessment) and pain and activity interference outcomes at 4-and 12-month follow-ups. Patients aged 45 years (N 1.477) completed a baseline interview; 1,311 and 1,157 of these comprised the 4- and 12-month analysis samples, respectively. Opioid use was classified based on self-report and electronic pharmacy records for the 120 days before the 4- and 12-month outcome assessments. Controlling for patient characteristics that predict sustained COT and pain outcomes, patients who had used opioids minimally or not at all, compared with those with intermittent/lower-dose and regular/higher-dose opioid use, had better pain intensity and activity interference outcomes. Adjusted mean (95% confidence interval) pain intensity (0-10 scale) at 12 months was 4.91 (4.68-5.13) for the minimal/no use group and 5.71 (5.50-5.92) and 5.72 (5.51-5.93) for the intermittent/lower-dose and regular/higher-dose groups, respectively. A similar pattern was observed for pain intensity at 4 months and for activity interference at both time points. Better outcomes in the minimal/no use group could reflect pain improvement leading to opioid discontinuation. The similarity in outcomes of regular/higher-dose and intermittent/lowerdose opioid users suggests that intermittent and/or lower-dose use vs higher-dose use may confer risk reduction without reducing benefits.

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