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Original Research: Kathryn Sullivan Dillie, Michael F. Fleming, Marlon P. Mundt, and Michael T. French Quality of Life Associated with Daily Opioid Therapy in a Primary Care Chronic Pain Sample J Am Board Fam Med 2008; 21: 108-117 [Abstract] [Full text] [PDF]

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Dose as a cause or result?

John L Bucek   (10 June 2008)

Dose as a cause or result? 10 June 2008
John L Bucek, Physician Somerset Family Medicine Residency Send response to journal: Re: Dose as a cause or result? jbucek{at}somerset-healthcare.com John L Bucek	When I saw that higher doses of opioid medications were associated with lower HRQoL scores, I imagined a patient that starts in pain, unable to function and after escalation of doses ends in pain, unable to function. Opioids are rarely started at these higher doses. Rather, the clinician and the patient evaluate the lower doses for effect on pain and function and increase the dose for effect. Why did the docs and patients not stop at the lower doses? My thought was the people whose pain and dysfunction do not respond get the dose escalations. In essence the way narcotic pain relievers are commonly titrated predicts that those who do not respond well will have the highest doses. I agree that these patients are not being served well by being on high dose medications with significant cost and side effects and sub optimal response. What is a doc to do? Should we skip trials of pain meds in the most dysfunctional of the patients? JLB