Correlates and outcomes of opioid dose escalation among chronic pain patients

描述（由申请人提供）：近年来，长期阿片类药物治疗慢性非癌性疼痛（CNCP）的使用急剧增加。虽然慢性阿片类药物治疗越来越普遍，但治疗结果在患者之间存在显着差异。提供者通常在疼痛恶化时增加阿片类药物剂量，这有可能降低疼痛强度，但可能增加药物相关不良反应或阿片类药物滥用的风险。此外，阿片类药物的副作用可能是剂量依赖性的。这项研究将确定临床因素，预测哪些患者会增加阿片类药物剂量。此外,

DESCRIPTION (provided by applicant): 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.