The complex association of daily opioid dose with visits for pain in sickle cell disease: tolerance or treatment refractory pain?

Higher outpatient opioid dosage predicted higher dosages during acute care visits to achieve the same pain score improvement, more consistent with opioid tolerance than treatment-refractory pain. The relationship of outpatient opioid dosage with number of acute care visits was more complex, suggesting opioid consumption at lower levels is driven by intermittent acute pain, and at higher levels by chronic pain.