A Randomized Trial of 2 Prescription Strategies for Opioid Treatment of Chronic Nonmalignant Pain
The Journal of Pain, 12/03/2010
Naliboff BD et al. – The use of opioid medications for treating chronic noncancer pain is growing; however, there is a lack of good evidence regarding their long–term effectiveness, association with substance abuse, and proper prescribing guidelines. The current study directly compares for the first time in a randomized trial the effectiveness of a conservative, hold the line (Stable Dose) prescribing strategy for opioid medications with a more liberal dose escalation (Escalating Dose) approach. The results of this study demonstrate that even in carefully selected patients there is a significant risk of problematic opioid misuse. Although in general there were no statistically significant differences in the primary outcomes between groups, the escalating dose strategy did lead to small improvements in self–reported acute relief from medications without an increase in opioid misuse, compared to the stable dose strategy.