Re: Quality of Life Associated with Daily Opioid Therapy in a Primary Care Chronic Pain Sample

To the Editor: I read with interest the recent article by Dillie and colleagues¹ in the March–April issue of the Journal of the American Board of Family Medicine but was disappointed that the authors failed to point out several obvious limitations to their conclusions. The authors concluded that patients in the 20 mg to 40 mg/d morphine equivalent group had significantly better Health Related Quality of Life (HRQoL) scores than their nonopioid treated or higher dosed counterparts. But what is still unknown, and not answered by this evaluation, is to what degree the prescribed opioid, assuming the patient is taking what is prescribed, has already improved those patients’ HRQoL since the initiation of opioid therapy? The authors note that a more appropriate comparison, but not very feasible, would have been to compare groups’ HRQoL with and without opioid therapy; but this was not done. Therefore, it is inaccurate to conclude that patients who were prescribed “high dose” opioids had lower HRQoL solely because of the total daily dose of their prescribed opioid.

The authors state that their findings “support recent recommendations that primary care physicians limit opioid dosing to <100 mg/d” and provide 3 references to support this conclusion. However, this conclusion is not supported by any of the cited references, nor is it supported by this or any other published study. This recommendation is also suspect because there is no mention by these authors, or any of the cited supporting studies, as to which opioid this recommendation this applies to. If not corrected, this study will only add to the confusion surrounding the appropriate use of opioids in non-cancer patients who experience pain rather than finding any meaningful solution for those in the greatest need.