Individual differences in opioid efficacy for chronic noncancer pain

Objective: Over a decade ago, Jamison noted the lack of studies that identify patient profiles or specific groups that might be best suited for opioid treatment of chronic noncancer pain. Methods: This paper reviews the studies that provide evidence for individual differences in opioid analgesia for chronic noncancer pain. Results: What we have found is that few investigations have addressed these important aspects of pain treatment. The most consistent finding is that depression and anxiety are associated with increased risk for drug abuse and decreased opioid efficacy. Discussion: The question remains whether the psychologic disorders antedated the pain condition or whether the experience of chronic pain exerts psychologic pressures that cause changes in behavior and psychologic processes. Additionally, the overall pattern suggests that younger age is predictive of opioid abuse and greater opioid efficacy. We also present a brief review of biologic mechanisms that support individual differences on opioid analgesia.