# Extended study of a long-term opioid therapy cohort: trajectories in pain care and patient-centered outcomes

> **NIH VA I01** · MINNEAPOLIS VA  MEDICAL CENTER · 2021 · —

## Abstract

Background: In response to evidence of serious harms and modest benefits associated with long-term opioid
therapy (LTOT), 2016 guidelines from the Centers for Disease Control and Prevention (CDC) and 2017
guidelines from the Department of Veterans Affairs (VA) and Department of Defense (DoD) recommend
limiting the frequency, intensity, and duration of opioid prescribing. For patients on LTOT, these guidelines
recommend tapering to reduced doses or discontinuation if benefits do not clearly outweigh harms. VA
initiatives to implement guideline recommendations have increased opioid reduction in practice and decreased
prevalence of LTOT, but effects on patients are unclear. Research is needed to understand long-term effects
of LTOT reduction or discontinuation on patients and how different treatment approaches may affect results.
Significance/Impact: Intended benefits of opioid reduction include improved function and quality of life and
decreased risk of overdose and death. Unintended negative consequences—such as worsened function and
increased risk of suicide—have been identified as potential harms, especially for high-risk patients or when
opioids are reduced in an abrupt or unsupported manner. Research is needed to better understand effects
over time of opioid prescribing and pain care practice changes on patient-centered outcomes, including pain-
related function, quality of life, and mortality.
Innovation: The Effects of Prescription Opioid Changes for Veterans (EPOCH) study is a prospective
longitudinal cohort study of VA patients treated with LTOT and a unique resource for understanding patient
outcomes of pain care practice changes. VA HSR&D funding supported establishment of a nationwide
population cohort of 271,892 VA patients treated with LTOT for at least 6 months before a 2016 index date. A
two-stage stratified sampling design was used to identify a representative sample of patients who were invited
to participate in a mixed-mode (mail and phone) survey. Of 14,160 patients invited, 9253 (65.3%) enrolled in
the survey panel. This project will expand analyses and extend long-term follow-up to a total of five years.
Specific Aims: The main objective of this study is to understand dynamic effects of changes in opioid
prescribing on patient-reported outcomes and mortality over time. Specific aims are to: 1) examine
associations over five years of time-varying opioid dose with pain-related function (primary outcome) and
quality of life; 2) examine different approaches to opioid dose reduction by a) characterizing patient subgroups
with distinct trajectories of opioid treatment over time and then b) evaluating associations of opioid treatment
trajectories with pain-related function (primary outcome) and quality of life; and 3) examine associations of
time-varying opioid dose with all-cause mortality and survival.
Methodology: This study will continue annual survey waves with patients in the existing survey panel at 48
and 60 months after base...

## Key facts

- **NIH application ID:** 10122751
- **Project number:** 5I01HX003063-02
- **Recipient organization:** MINNEAPOLIS VA  MEDICAL CENTER
- **Principal Investigator:** Erin Elizabeth Krebs
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2020-03-01 → 2025-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10122751

## Citation

> US National Institutes of Health, RePORTER application 10122751, Extended study of a long-term opioid therapy cohort: trajectories in pain care and patient-centered outcomes (5I01HX003063-02). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/10122751. Licensed CC0.

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