Research from the VA has delivered yet another a reality check for healthcare providers who are considering increased opioid doses for patients with chronic pain. Recent analysis shows that patients who received increasing doses of pain medication did not have meaningful reductions in their pain when compared against patients whose doses remained the same.

“Opioid dose escalation among patients with chronic pain is not associated with improvements in pain scores,” says the study, which was co-authored by Brad Martin (PharmD, PhD) and Corey Hayes (PharmD, PhD) from the University of Arkansas for Medical Science (UAMS). Results were published in the January 9, 2020 issue of the journal Pain.

Results Drawn from Over 50,000 VA Patients

Martin and Hayes, who worked in conjunction with researchers from the Central Arkansas and Minneapolis VA Healthcare Systems, studied records from a pool of over 50,000 Veteran patients with chronic pain issues who received opioid therapy between 2008 and 2015. Patients were treated for a variety of chronic conditions, including arthritis, back pain, neck pain, neuropathic pain and headache/migraine.

Patients were evaluated in two groups – the “dose escalators,” who had more than a 20 percent increase in their average daily doses; and the “dose maintainers,” who did not have their average daily doses changed significantly during the study period. All patients were assessed over two consecutive six-month periods, and all pain scores were measured using the Numeric Rating Scale.

Analysis shows that pain scores were moderately, yet consistently, higher among the dose-escalator group during the intervals studied. In addition, dose-escalator pain scores did not reveal any significant reductions as the medication doses were increased. Specifically, average pain scores only decreased by 0.1 after 180 days of increased dosage. Changes in pain ratings must be at least 0.5 to be medically meaningful, say the researchers.

Hayes concludes that “the pain relief the provider and the patient are going for really isn’t there when they increase their doses.”

Companion Study Shows Increased Risks

Pain is a well-documented condition among Veterans, with more than 50 percent of VA primary care patients suffering from chronic pain. It’s also a well-established risk factor for opioid use disorder and opioid-related overdose.

As a case in point, a companion study conducted by the same team confirmed that escalating the use of opioids for patients with chronic pain is associated with increased risks of substance abuse and adverse outcomes like addiction.

Of these results, Hayes concludes, “You don’t see the benefit, but you do see the risk.” The study was published in the January 15, 2020 issue of the journal Addiction.

Alternative Therapies May Improve Outcomes

These results add to the growing body of evidence that has prompted major reductions in opioid prescribing. In fact, VA statistics show that as of 2016 roughly 16 percent of VA patients received opioid prescriptions, which is down 25 percent from 2013. The is mostly due to a reduction in long-term prescribing, as opposed lowered short-term use for acute pain.

They have also given renewed momentum to pain management alternatives such as acupuncture, yoga, massage and electrotherapy. The push is supported, in part, by another recent VA study demonstrating that service members who receive non-drug therapies as part of their pain treatment plans have lower risks for alcohol and drug disorders. The analysis, led by Dr. Esther Meerwijk from the VA Palo Alto Health Care System, found that those who received non-drug therapies were 35 percent less likely to injure themselves than those who didn’t receive such therapies.

“If non-drug treatments make chronic pain more bearable, people may be more likely to have positive experiences in life,” says Meerwijk.

The Take-Away

As newly published research continues to evolve our understanding of pain treatment, it’s expected that healthcare providers will continue to rely less and less on opioids and instead incorporate a wider array of alternative therapies that have shown promising results.

Those wanting further education regarding alternative pain therapies may wish to review the following:

Take the Next Step

If you’re a healthcare provider interested in learning more about non-opioid pain management options for your patients, complete the form below and check the box to receive a virtual product demo of the RS-4i® Plus. Then judge for yourself how this Interferential therapy device, which has helped over 21,000 Veterans nationwide, can work for your patients.

Related Resources

Blog: Non-Drug Therapies May Improve Outcomes for Soldiers with Chronic Pain
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VA Research Update: Increasing Opioid Doses Fails to Reduce Pain