Guideline-basedvs.high-doseopioidtherapy

Better outcomes with guideline-compliant dosing

Guideline-appropriate opioid therapy is associated with better health and economic outcomes compared to high-dose therapy.

Publication data

Journal: Pain
Publication: January 2018
Authors: Häuser, Schubert, Scherbaum, Tölle
Type of study: Retrospective cross-sectional study
Data base: 4,028,618 insured persons from 69 statutory health insurance funds

Authors and affiliations

Department Internal Medicine 1, Klinikum Saarbrücken, Saarbrücken, Germany Winfried Häuser Department Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Munich, Germany Winfried HäuserLinkCare GmbH, Stuttgart, Germany Tino Schubert LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Duisburg-Essen, Essen, Germany Norbert Scherbaum Department Neurology, Technical University of Munich, Munich, Germany Thomas Tölle

This retrospective cross-sectional study investigates whether guideline-based long-term opioid therapy for chronic non-tumour-related pain is associated with better outcomes than high-dose opioid therapy. It is based on a representative German insurance database.

Key results

Prevalence of long-term opioid therapy: 0.8 % Proportion of high-dose therapy: 9.9 % of LTOT patients Risky co-prescribing: 11.1 % with guideline-based therapy vs. 14.3 % with high-dose therapy Inpatient admissions due to substance-related diagnoses: 1.6 % vs. 2.9 % Total costs: € 7,259 vs. € 10,732 per patient.

Classification and conclusion

The results confirm that high-dose opioid therapy is associated with higher risks and higher costs. The data support existing recommendations to adhere to defined dose thresholds for chronic non-tumour-related pain. Long-term opioid therapy in line with guidelines is associated with more favourable outcomes than high-dose therapy. The study reinforces the importance of controlled, dose-sensitive pain therapy.