Predictors of opioid efficacy in patients with chronic pain: A prospective multicenter observational cohort study

Kasper Grosen; Anne E Olesen; Mikkel Gram; Torsten Jonsson; Michael Kamp-Jensen; Trine Andresen; Christian Nielsen; Gorazd Pozlep; Mogens Pfeiffer-Jensen; Bart Morlion; Asbjørn M Drewes

doi:10.1371/journal.pone.0171723

Predictors of opioid efficacy in patients with chronic pain: A prospective multicenter observational cohort study

Kasper Grosen, Anne E Olesen, Mikkel Gram, Torsten Jonsson, Michael Kamp-Jensen, Trine Andresen, Christian Nielsen, Gorazd Pozlep, Mogens Pfeiffer-Jensen, Bart Morlion, Asbjørn M Drewes

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Abstract

Opioids are increasingly used for treatment of chronic pain. However, they are only effective in a subset of patients and have multiple side effects. Thus, studies using biomarkers for response are highly warranted. The current study prospectively examined 63 opioid-naïve patients initiating opioid use for diverse types of chronic pain at five European centers. Quantitative sensory testing, electroencephalography (EEG) recordings, and assessment of pain catastrophizing were performed prior to treatment. The co-primary outcomes were change from baseline in ratings of chronic pain and quality of life after 14 days of opioid treatment. Secondary outcomes included patient's global impression of clinical change and side effects. Logistic regression models adjusted for age and sex were used to identify biomarkers predictive for successful treatment, defined as at least a 30% reduction in average pain intensity or an improvement in quality of life of at least 10 scale points. Fifty-nine patients (94%) completed the study. The mean age was 55 ± 16 years and 69% were females. Pain reduction was predicted by cold pain intensity (OR: 0.69; P = 0.01), pain catastrophizing (OR: 0.82; P = 0.03), relative delta (OR: 0.76; P = 0.03) and beta EEG activity (OR: 1.18; P = 0.04) induced by experimental cold pain. None of the study variables were related to improvement in quality of life. For the first time, individual pain processing characteristics have been linked to opioid response in a mixed chronic pain population. This has the potential to personalize treatment of chronic pain and restrict opioid use to patients with high likelihood for response.

Original language	English
Article number	e0171723
Journal	PloS one
Volume	12
Issue number	2
Number of pages	13
ISSN	1932-6203
DOIs	https://doi.org/10.1371/journal.pone.0171723
Publication status	Published - Feb 2017

Keywords

Adult
Aged
Analgesics, Opioid
Chronic Pain
Female
Humans
Male
Middle Aged
Pain Measurement
Prospective Studies
Quality of Life
Treatment Outcome
Journal Article
Multicenter Study

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10.1371/journal.pone.0171723Licence: CC BY

journal.pone.0171723Licence: CC BY

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title = "Predictors of opioid efficacy in patients with chronic pain: A prospective multicenter observational cohort study",

abstract = "Opioids are increasingly used for treatment of chronic pain. However, they are only effective in a subset of patients and have multiple side effects. Thus, studies using biomarkers for response are highly warranted. The current study prospectively examined 63 opioid-na{\"i}ve patients initiating opioid use for diverse types of chronic pain at five European centers. Quantitative sensory testing, electroencephalography (EEG) recordings, and assessment of pain catastrophizing were performed prior to treatment. The co-primary outcomes were change from baseline in ratings of chronic pain and quality of life after 14 days of opioid treatment. Secondary outcomes included patient's global impression of clinical change and side effects. Logistic regression models adjusted for age and sex were used to identify biomarkers predictive for successful treatment, defined as at least a 30% reduction in average pain intensity or an improvement in quality of life of at least 10 scale points. Fifty-nine patients (94%) completed the study. The mean age was 55 ± 16 years and 69% were females. Pain reduction was predicted by cold pain intensity (OR: 0.69; P = 0.01), pain catastrophizing (OR: 0.82; P = 0.03), relative delta (OR: 0.76; P = 0.03) and beta EEG activity (OR: 1.18; P = 0.04) induced by experimental cold pain. None of the study variables were related to improvement in quality of life. For the first time, individual pain processing characteristics have been linked to opioid response in a mixed chronic pain population. This has the potential to personalize treatment of chronic pain and restrict opioid use to patients with high likelihood for response.",

keywords = "Adult, Aged, Analgesics, Opioid, Chronic Pain, Female, Humans, Male, Middle Aged, Pain Measurement, Prospective Studies, Quality of Life, Treatment Outcome, Journal Article, Multicenter Study",

author = "Kasper Grosen and Olesen, {Anne E} and Mikkel Gram and Torsten Jonsson and Michael Kamp-Jensen and Trine Andresen and Christian Nielsen and Gorazd Pozlep and Mogens Pfeiffer-Jensen and Bart Morlion and Drewes, {Asbj{\o}rn M}",

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AU - Grosen, Kasper

AU - Olesen, Anne E

AU - Gram, Mikkel

AU - Jonsson, Torsten

AU - Kamp-Jensen, Michael

AU - Andresen, Trine

AU - Nielsen, Christian

AU - Pozlep, Gorazd

AU - Pfeiffer-Jensen, Mogens

AU - Morlion, Bart

AU - Drewes, Asbjørn M

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N2 - Opioids are increasingly used for treatment of chronic pain. However, they are only effective in a subset of patients and have multiple side effects. Thus, studies using biomarkers for response are highly warranted. The current study prospectively examined 63 opioid-naïve patients initiating opioid use for diverse types of chronic pain at five European centers. Quantitative sensory testing, electroencephalography (EEG) recordings, and assessment of pain catastrophizing were performed prior to treatment. The co-primary outcomes were change from baseline in ratings of chronic pain and quality of life after 14 days of opioid treatment. Secondary outcomes included patient's global impression of clinical change and side effects. Logistic regression models adjusted for age and sex were used to identify biomarkers predictive for successful treatment, defined as at least a 30% reduction in average pain intensity or an improvement in quality of life of at least 10 scale points. Fifty-nine patients (94%) completed the study. The mean age was 55 ± 16 years and 69% were females. Pain reduction was predicted by cold pain intensity (OR: 0.69; P = 0.01), pain catastrophizing (OR: 0.82; P = 0.03), relative delta (OR: 0.76; P = 0.03) and beta EEG activity (OR: 1.18; P = 0.04) induced by experimental cold pain. None of the study variables were related to improvement in quality of life. For the first time, individual pain processing characteristics have been linked to opioid response in a mixed chronic pain population. This has the potential to personalize treatment of chronic pain and restrict opioid use to patients with high likelihood for response.

AB - Opioids are increasingly used for treatment of chronic pain. However, they are only effective in a subset of patients and have multiple side effects. Thus, studies using biomarkers for response are highly warranted. The current study prospectively examined 63 opioid-naïve patients initiating opioid use for diverse types of chronic pain at five European centers. Quantitative sensory testing, electroencephalography (EEG) recordings, and assessment of pain catastrophizing were performed prior to treatment. The co-primary outcomes were change from baseline in ratings of chronic pain and quality of life after 14 days of opioid treatment. Secondary outcomes included patient's global impression of clinical change and side effects. Logistic regression models adjusted for age and sex were used to identify biomarkers predictive for successful treatment, defined as at least a 30% reduction in average pain intensity or an improvement in quality of life of at least 10 scale points. Fifty-nine patients (94%) completed the study. The mean age was 55 ± 16 years and 69% were females. Pain reduction was predicted by cold pain intensity (OR: 0.69; P = 0.01), pain catastrophizing (OR: 0.82; P = 0.03), relative delta (OR: 0.76; P = 0.03) and beta EEG activity (OR: 1.18; P = 0.04) induced by experimental cold pain. None of the study variables were related to improvement in quality of life. For the first time, individual pain processing characteristics have been linked to opioid response in a mixed chronic pain population. This has the potential to personalize treatment of chronic pain and restrict opioid use to patients with high likelihood for response.

KW - Adult

KW - Aged

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KW - Female

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KW - Male

KW - Middle Aged

KW - Pain Measurement

KW - Prospective Studies

KW - Quality of Life

KW - Treatment Outcome

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JO - PloS one

JF - PloS one

IS - 2

M1 - e0171723

ER -

Predictors of opioid efficacy in patients with chronic pain: A prospective multicenter observational cohort study

Abstract

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