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Self-reported cumulative medical opioid exposure and subjective responses on first use of opioids predict analgesic and subjective responses to placebo-controlled opioid administration
  1. Stephen Bruehl1,
  2. Amanda L Stone1,2,
  3. Cassandra Palmer1,
  4. David A Edwards1,
  5. Asokumar Buvanendran3,
  6. Rajnish Gupta1,
  7. Melissa Chont1,
  8. Mary Kennedy4 and
  9. John W Burns4
  1. 1 Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  2. 2 Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
  3. 3 Department of Anesthesiology, Rush University, Chicago, Illinois, USA
  4. 4 Department of Behavioral Science, Rush University, Chicago, Illinois, USA
  1. Correspondence to Stephen Bruehl, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37221, USA; Stephen.Bruehl{at}vumc.org

Abstract

Background and objectives To expand the evidence base needed to enable personalized pain medicine, we evaluated whether self-reported cumulative exposure to medical opioids and subjective responses on first opioid use predicted responses to placebo-controlled opioid administration.

Methods In study 1, a survey assessing cumulative medical opioid exposure and subjective responses on first opioid use was created (History of Opioid Medical Exposure (HOME)) and psychometric features documented in a general sample of 307 working adults. In study 2, 49 patients with chronic low back pain completed the HOME and subsequently rated back pain intensity and subjective opioid effects four times after receiving saline placebo or intravenous morphine (four incremental doses) in two separate double-blinded laboratory sessions. Placebo-controlled morphine effects were derived for all outcomes.

Results Two HOME subscales were supported: cumulative opioid exposure and euphoric response, both demonstrating high test–retest reliability (Intraclass Correlation Coefficients > 0.93) and adequate internal consistency (Revelle’s Omega Total = 0.73–0.77). In study 2, higher cumulative opioid exposure scores were associated with significantly greater morphine-related reductions in back pain intensity (p=0.02), but not with subjective drug effects. Higher euphoric response subscale scores were associated with significantly lower overall perceived morphine effect (p=0.003), less sedation (p=0.04), greater euphoria (p=0.03) and greater desire to take morphine again (p=0.02).

Discussion Self-reports of past exposure and responses to medical opioid analgesics may have utility for predicting subsequent analgesic responses and subjective effects. Further research is needed to establish the potential clinical and research utility of the HOME.

Trial registration number NCT02469077.

  • opioid
  • analgesic
  • chronic pain
  • misuse
  • subjective effects
  • questionnaire
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Footnotes

  • Presented at Bienniel meetings of the International Association for the Study of Pain (September 2018), Boston, Massachusetts.

  • Funding This research was supported by NIH Grant R01DA037891 and CTSA award UL1TR002243 from the National Center for Advancing Translational Sciences. ALS is a TL1 scholar supported by National Center for Advancing Translational Sciences of the National Institutes of Health under award number TL1TR002371.

  • Disclaimer Contents of this work are solely the responsibility of the authors and do not necessarily represent official views of the National Center for Advancing Translational Sciences or the National Institutes of Health.

  • Competing interests None declared.

  • Patient consent Informed consent was obtained from all participants prior to study participation.

  • Ethics approval All study 1 procedures were approved by the Vanderbilt University Medical Center Institutional Review Board (protocol #171274, approved 15 August 2017). All study 2 procedures were approved by the Institutional Review Boards at the respective institutions (Vanderbilt IRB: protocol #141862, approved 2 February 2015; Rush IRB: protocol #14051410, Approved 29 January 2015).

  • Provenance and peer review Not commissioned; externally reviewed

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