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Comparative Study
. 2011 Sep;12(9):953-63.
doi: 10.1016/j.jpain.2011.02.357. Epub 2011 Jun 16.

Elevated pain sensitivity in chronic pain patients at risk for opioid misuse

Robert R Edwards  1 , Ajay D Wasan, Ed Michna, Seth Greenbaum, Ed Ross, Robert N Jamison
Affiliations
Comparative Study

Elevated pain sensitivity in chronic pain patients at risk for opioid misuse

Robert R Edwards et al. J Pain. 2011 Sep.

Abstract

This study employed quantitative sensory testing (QST) to evaluate pain responses in chronic spinal pain patients at low risk and high risk for opioid misuse, with risk classification based on scores on the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R). Patients were further subgrouped according to current use of prescription opioids. Of the 276 chronic pain patients tested, approximately 65% were taking opioids; a median split was used to further categorize these patients as being on lower or higher doses of opioids. The high-risk group (n = 161) reported higher levels of clinical pain, had lower pressure and thermal pain thresholds at multiple body sites, had lower heat pain tolerance, and rated repetitive mechanical stimuli as more painful relative to the low-risk group (n = 115; P's < .01). In contrast, QST measures did not differ across opioid groups. Multiple linear regression analysis suggested that indices of pain-related distress (ie, anxiety and catastrophizing about pain) were also predictive of hyperalgesia, particularly in patients taking opioids. Collectively, regardless of opioid status, the high-risk group was hyperalgesic relative to the low-risk group; future opioid treatment studies may benefit from the classification of opioid risk, and the examination of pain sensitivity and other factors that differentiate high- and low-risk groups.

Perspective: This study demonstrates that chronic spinal pain patients at high risk for misuse of prescription opioids are more pain-sensitive than low-risk patients, whether or not they are currently taking opioids. Indices of pain-related distress were important predictors of pain sensitivity, particularly among those patients taking opioids for pain.

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Conflict of interest statement

Disclosures: None of the authors have any financial or other conflicts of interest with regard to this study or its findings.

Figures

Figure 1
Figure 1
Pain ratings (0–100) for punctuate mechanical stimuli as a function of opioid use and risk group (mean ± SEM). Panel A= No Opioids, Panel B= Lower-Dose Opioids, Panel C= Higher-Dose Opioids.
Figure 2
Figure 2
Pressure pain thresholds (in kPa) as a function of opioid use and risk group (mean ± SEM). Panel A= No Opioids, Panel B= Lower-Dose Opioids, Panel C= Higher-Dose Opioids.
Figure 3
Figure 3
Thermal responses as a function of opioid use and risk group (mean ± SEM). Panel A= No Opioids, Panel B= Lower-Dose Opioids, Panel C= Higher-Dose Opioids.
See this image and copyright information in PMC

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