Assessment of dosing frequency of sustained-release opioid preparations in patients with chronic nonmalignant pain.Pain Med. 2007 Jan-Feb; 8(1):71-4.PM
Many patients with moderate to severe chronic nonmalignant pain require dosing of long-acting opioids more frequently than recommended by the product's manufacturer. To accurately quantitate opioid dosing in clinical practice, daily dosing was prospectively assessed in pain clinic patients.
A single-center, 30-day, prospective, observational cohort study, approved by the hospital IRB.
Forty-one evaluable adult outpatients receiving treatment with long-acting opioids for moderate to severe chronic nonmalignant pain.
The primary measure was the daily number of consumed doses of prescribed long-acting opioid. Rescue medication use, average daily pain intensity, and patient-reported adverse events were also recorded.
The mean daily number of doses was 3.0 for oxycodone controlled release (CR), 2.9 for morphine CR, and 3.7 for methadone. For transdermal fentanyl, 50% of patients required dosing every 24-48 hours. Ninety-one percent of oxycodone CR-treated patients, 86% of morphine CR-treated patients, and 50% of fentanyl patch-treated patients required dosing more frequently than that recommended by the product's manufacturer. Patients who received oxycodone CR, morphine CR, and transdermal fentanyl required a mean of 2.9, 2.9, and 3.7 rescue doses per day, respectively.
Many patients taking common long-acting opioids for chronic nonmalignant pain require dosing more frequently than recommended by product labeling, and take an additional 3-4 daily doses of rescue opioid, yet they continue to report moderate to severe pain. Newer opioid formulations that can provide sustained analgesia with convenient dosing are needed as well as a better understanding of the many additional factors that may influence opioid use patterns in patients with chronic pain.