ArticlePain medicine (Malden, Mass.)2015
Dose escalation during the first year of long-term opioid therapy for chronic pain.
Article in Pain medicine (Malden, Mass.), 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
26 citing papers in PubMed, 43 citations in OpenAlex.
- Mindfulness-oriented recovery enhancement reduces opioid dose in primary care by strengthening autonomic regulation during meditation.The American psychologist · 2020Trial
- Development of the Chronic Pain Coding System (CPCS) for Characterizing Patient-Clinician Discussions About Chronic Pain and Opioids.Pain medicine (Malden, Mass.) · 2016Trial
- Patterns of opioid dose escalation in patients with chronic kidney disease initiated on opioids for the treatment of non-cancer pain.PloS one · 2026Article
- Buprenorphine Substitution as a Tapering Strategy for Opioid Discontinuation in Patients with Chronic Pain: A Nonrandomized and Proof of Concept Study.Pain and therapy · 2025Article
- Long-Term Opioid Therapy and Risk of Opioid Overdose by Derived Clinical Indication in North Carolina, 2006-2018.Pharmacoepidemiology and drug safety · 2025Article
- Opioid therapy trajectories of patients with chronic non-cancer pain over 1 year of follow-up after initiation of short-acting opioid formulations.Pain medicine (Malden, Mass.) · 2024Article
- Glycine Transporter 1 Inhibitors: Predictions on Their Possible Mechanisms in the Development of Opioid Analgesic Tolerance.Biomedicines · 2024Review
- Sex-specific role of the circadian transcription factor NPAS2 in opioid tolerance, withdrawal and analgesia.Genes, brain, and behavior · 2022Article
- Trajectories of prescription opioid dose and risk of opioid-related adverse events among older Medicare beneficiaries in the United States: A nested case-control study.PLoS medicine · 2022Article
- Mu-opioid receptor and receptor tyrosine kinase crosstalk: Implications in mechanisms of opioid tolerance, reduced analgesia to neuropathic pain, dependence, and reward.Frontiers in systems neuroscience · 2022Review
- Escalation and reinstatement of fentanyl self-administration in male and female rats.Psychopharmacology · 2021Article
- Prospective Investigation of Factors Associated with Prescription Opioid Dose Escalation among Patients in Integrated Health Systems.Journal of general internal medicine · 2020Article
- Nonconsensual Dose Reduction Mandates are Not Justified Clinically or Ethically: An Analysis.The Journal of law, medicine & ethics : a journal of the American Society of Law, Medicine & Ethics · 2020Article
- Impact of opioid dose escalation on the development of substance use disorders, accidents, self-inflicted injuries, opioid overdoses and alcohol and non-opioid drug-related overdoses: a retrospective cohort study.Addiction (Abingdon, England) · 2020Article
- Article
- Consensus Statement for the Prescription of Pain Medication at Discharge after Elective Adult Surgery.Canadian journal of pain = Revue canadienne de la douleur · 2020Article
- Factors Associated with Prescription Opioid Analgesic Use in the US Population, 2011-2014.Pain medicine (Malden, Mass.) · 2019Article
- Brain-Permeant and -Impermeant Inhibitors of Fatty Acid Amide Hydrolase Synergize with the Opioid Analgesic Morphine to Suppress Chemotherapy-Induced Neuropathic Nociception Without Enhancing Effects of Morphine on Gastrointestinal Transit.The Journal of pharmacology and experimental therapeutics · 2018Article
- Article
- Goals of Chronic Pain Management: Do Patients and Primary Care Physicians Agree and Does it Matter?The Clinical journal of pain · 2017Article
Corrections and comments
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
Abstract
objectiveTo identify patient factors and health care utilization patterns associated with dose escalation during the first year of long-term opioid therapy for chronic pain.
designRetrospective cohort study using electronic health record data.
settingUniversity health system. SUBJECTS: Opioid naïve adults with musculoskeletal pain who received a new outpatient opioid prescription between July 1, 2011 and June 30, 2012 and stayed on opioids for 1 year.
methodsMixed-effects regression was used to estimate patients' rate of opioid dose escalation. Demographics, clinical characteristics, and health care utilization for patients with and without dose escalation were compared.
resultsTwenty-three (9%) of 246 patients in the final cohort experienced dose escalation (defined as an increase in mean daily opioid dose of ≥30-mg morphine equivalents over 1 year). Compared with patients without dose escalation, patients with escalation had higher rates of substance use diagnoses (17% vs 1%, P = 0.01) and more total outpatient encounters (51 vs 35, P = 0.002) over 1 year. Differences in outpatient encounters were largely due to more non face-to-face encounters (e.g., telephone calls, emails) among patients with dose escalation. Differences in age, race, concurrent benzodiazepine use, and mental health diagnoses between patients with and without dose escalation were not statistically significant. Primary care clinicians prescribed 89% of opioid prescriptions.
conclusionsDose escalation during the first year of long-term opioid therapy is associated with higher rates of substance use disorders and more frequent outpatient encounters, especially non face-to-face encounters.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.