The Social and Functional Implications of
High- Versus Low-Dose Opioids on Chronic
Non-Cancer Pain
Authors: Denawa Yohei 
Published: February 2021

Background: Chronic non-cancer pain (CNCP) is a major health concern. Opioids may be a useful
treatment option, but their use still remains controversial given the significant risks and epidemic of
opioid addiction and abuse. There is limited data on whether opioid therapy is an effective treatment
option for chronic non-cancer pain.
Objective: To assess both physical and emotional dimensions of health for patients on opioid therapy
for CNCP by reviewing the 36-Item Short Form Health Survey (SF-36) .
Study Design: This study was a retrospective cohort review.
Setting: Outpatient pain clinic
Methods: We recruited 182 patients at the West Penn Pain Institute outpatient pain clinic: 94 patients
were recruited for the low-dose opioid group (5-30 morphine milligram equivalents [MME]) while 88
patients were recruited for the high-dose opioid group (> 90 MME). Each patient filled out the SF-36
survey used to assess both the physical and emotional dimensions of their health. We also analyzed
patients’ employment status, reasons for unemployment, pain diagnosis, side effects, and compliance
issues through the electronic medical record (EMR).
Results: Mean scores on General Health Perceptions for the low-dose and high-dose opioid groups were
50.3 ± 21.6 and 44.4 ± 21.9, respectively (P = .07). Though not reaching statistical significance, highdose patients had lower item scores, indicating a perception of poorer health. There were no significant
differences between the low-dose and high-dose opioid treatment groups on any of the mean scores
from the 8 domains of the SF-36.
There was a statistically significant association between opioid treatment group and working status,
noncompliance, and the self-reported number of side effects. Patients treated with high-dose opioids had
significantly higher rates of unemployment (85%) than did low-dose opioid patients (66%) (χ2
[1] = 8.48, P
=.004; odds ratio [OR] = 2.89 [95% confidence interval (CI), 1.39-6.01]). Unemployed patients in the highdose treatment group were more likely to list disability as unemployment while retirement was the most
common response in the low-dose treatment group. Patients treated with high-dose opioids had significantly
higher rates of self-reported side effects (46%) than did low-dose opioid patients (21%) (χ2
[1] = 12.02, P
=.001; OR = 3.08 [95% CI, 1.61-5.89]). Patients treated with high-dose opioids had significantly higher rates
of noncompliance (49%) than did low-dose opioid patients (33%) (χ2
[1] = 4.75, P =.029; OR = 1.94 [95%
CI, 1.07-3.54]). Thus, the odds of a high-dose opioid patient being unemployed were 2.89 times greater than
the odds for a low-dose opioid patient; the odds of a high-dose opioid patient self-reporting side-effects were
3.08 times greater than the odds for a low-dose opioid patient; and the odds of a high-dose opioid patient
being noncompliant with their medications were 1.94 times greater than the odds for a low-dose opioid
patient.
Limitations: The observation al design prohibits drawing causal relationships, and entry criteria was
restricted.
Conclusions: These data suggest that patients receiving low-dose and high-dose opioid treatment do
not have significantly different quality-of-life outcomes. Future studies that incorporate longitudinal data
are necessary to examine the temporal relationship between quality of life and opioid therapy.
Key words: Chronic pain, chronic non-cancer pain, opioids, pain, quality of life, side effects,
noncompliance, unemployment