Chronic Noncancer Pain and the Long Term Utility of Opioids

OBJECTIVE:To report on a long term experience in treating patients with chronic noncancer pain (CNCP).METHODS:One hundred two patients with CNCP were seen every three months and followed for one year or more (median eight years, range one to 22). Demographic data, diagnostic categories and response to therapies were recorded. The utility and safety of opioid therapy, adverse events, impact on disability and issues related to previous psychiatric or chemical dependency history were documented.RESULTS:Most patients reported a variety of neuropathic pain problems and most required chronic opioid therapy after the failure of other treatments. Although 44% reported being satisfied with pain relief despite adverse events, it is noteworthy that the remaining patients chose to continue therapy for the modest benefit of pain relief despite adverse events. Moreover, 54% were less disabled on opioid therapy.CONCLUSIONS:This is a large sample of CNCP patients, most taking opioids over a long period of time. CNCP can be treated by opioids safely and with a modest effect, with improvement in functioning in some patients who are refractory to other measures. If care is taken, opioids may even be used effectively for patients with a history of chemical dependency.

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Long-term opioid therapy for chronic noncancer pain: second update of the German guidelines

PAIN Reports ◽

10.1097/pr9.0000000000000840 ◽

2020 ◽

Vol 5 (5) ◽

pp. e840

Author(s):

Frank Petzke ◽

Frietjof Bock ◽

Michael Hüppe ◽

Monika Nothacker ◽

Heike Norda ◽

...

Keyword(s):

Opioid Therapy ◽

Chronic Noncancer Pain ◽

Noncancer Pain

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Guideline-recommended vs high-dose long-term opioid therapy for chronic noncancer pain is associated with better health outcomes

Pain ◽

10.1097/j.pain.0000000000001067 ◽

2018 ◽

Vol 159 (1) ◽

pp. 85-91 ◽

Cited By ~ 15

Author(s):

Winfried Häuser ◽

Tino Schubert ◽

Norbert Scherbaum ◽

Thomas Tölle

Keyword(s):

Health Outcomes ◽

Opioid Therapy ◽

High Dose ◽

Chronic Noncancer Pain ◽

Noncancer Pain

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Changes in pain intensity after discontinuation of long-term opioid therapy for chronic noncancer pain

Pain ◽

10.1097/j.pain.0000000000001315 ◽

2018 ◽

Vol 159 (10) ◽

pp. 2097-2104 ◽

Cited By ~ 13

Author(s):

Sterling McPherson ◽

Crystal Lederhos Smith ◽

Steven K. Dobscha ◽

Benjamin J. Morasco ◽

Michael I. Demidenko ◽

...

Keyword(s):

Pain Intensity ◽

Opioid Therapy ◽

Chronic Noncancer Pain ◽

Noncancer Pain

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Opioid Misuse and Addiction Among Patients With Chronic Pain

Pain Care Essentials ◽

10.1093/med/9780199768912.003.0021 ◽

2019 ◽

pp. 339-354

Author(s):

Marc O. Martel ◽

Robert N. Jamison

Keyword(s):

Chronic Pain ◽

Opioid Therapy ◽

Screening Tools ◽

Prescription Opioid ◽

Opioid Misuse ◽

Chronic Noncancer Pain ◽

Medication Misuse ◽

Opioid Medications ◽

Noncancer Pain

Chapter 20 provides an introduction to understanding the prevalence and risk factors as well as screening tools for assessing opioid misuse and addiction in patients with chronic pain. In the era of the opioid epidemic in North America and beyond, the use of prescription opioid medications to help improve function in chronic noncancer pain is frequently debated. Out of fear of iatrogenic addiction, litigation, and/or potential medication misuse, some clinicians are refusing to prescribe opioids for chronic pain. Evidence indicates that rates of opioid misuse and addiction are fairly high among chronic pain patients prescribed long-term opioid therapy, but there is consensus that opioids can be safe and effective for carefully selected and monitored patients.

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A Two-Year Prospective Multicenter Study of Opioid Therapy for Chronic Noncancer Pain: Prescription Trends and Predictors

Pain Medicine ◽

10.1093/pm/pny275 ◽

2018 ◽

Vol 20 (11) ◽

pp. 2166-2178 ◽

Cited By ~ 1

Author(s):

Dalila R Veiga ◽

Liliane Mendonça ◽

Rute Sampaio ◽

José M Castro-Lopes ◽

Luís F Azevedo

Keyword(s):

Chronic Pain ◽

Clinical Outcomes ◽

Opioid Therapy ◽

Opioid Use ◽

Opioid Prescription ◽

Chronic Noncancer Pain ◽

Noncancer Pain ◽

Opioid Users

Abstract Objectives Opioid use in chronic pain has increased worldwide in recent years. The aims of this study were to describe the trends and patterns of opioid therapy over two years of follow-up in a cohort of chronic noncancer pain (CNCP) patients and to assess predictors of long-term opioid use and clinical outcomes. Methods A prospective cohort study with two years of follow-up was undertaken in four multidisciplinary chronic pain clinics. Demographic data, pain characteristics, and opioid prescriptions were recorded at baseline, three, six, 12, and 24 months. Results Six hundred seventy-four CNCP patients were recruited. The prevalence of opioid prescriptions at baseline was 59.6% (N = 402), and 13% (N = 86) were strong opioid prescriptions. At 24 months, opioid prescription prevalence was as high as 74.3% (N = 501), and strong opioid prescription was 31% (N = 207). Most opioid users (71%, N = 479) maintained their prescription during the two years of follow-up. Our opioid discontinuation was very low (1%, N = 5). Opioid users reported higher severity and interference pain scores, both at baseline and after two years of follow-up. Opioid use was independently associated with continuous pain, pain location in the lower limbs, and higher pain interference scores. Conclusions This study describes a pattern of increasing opioid prescription in chronic pain patients. Despite the limited improvement of clinical outcomes, most patients keep their long-term opioid prescriptions. Our results underscore the need for changes in clinical practice and further research into the effectiveness and safety of chronic opioid therapy for CNPC.

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Tapering Long-term Opioid Therapy in Chronic Noncancer Pain

Mayo Clinic Proceedings ◽

10.1016/j.mayocp.2015.04.003 ◽

2015 ◽

Vol 90 (6) ◽

pp. 828-842 ◽

Cited By ~ 102

Author(s):

Chantal Berna ◽

Ronald J. Kulich ◽

James P. Rathmell

Keyword(s):

Opioid Therapy ◽

Chronic Noncancer Pain ◽

Noncancer Pain

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How Effective Is Long-term Opioid Therapy for Chronic Noncancer Pain?

Clinical Journal of Pain ◽

10.1097/ajp.0b013e318032de5d ◽

2007 ◽

Vol 23 (4) ◽

pp. 300-302 ◽

Cited By ~ 19

Author(s):

Michael C. Rowbotham ◽

Calandra Diamond Lindsey

Keyword(s):

Opioid Therapy ◽

Chronic Noncancer Pain ◽

Noncancer Pain

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Perspectives of pain specialists, patients, and family members on long-term opioid use for chronic non-cancer pain: a qualitative study

BMC Anesthesiology ◽

10.1186/s12871-021-01501-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Rattaphol Seangrung ◽

Thongchai Tempeetikul ◽

Supasit Pannarunothai ◽

Supalak Sakdanuwatwong

Keyword(s):

Pain Management ◽

Pain Relief ◽

Qualitative Study ◽

Adverse Events ◽

Cancer Pain ◽

Family Members ◽

Opioid Therapy ◽

Functional Improvement ◽

Opioid Use

Abstract Background Opioids are currently prescribed for chronic non-cancer pain (CNCP), and some patients use opioids continuously for long-term treatment. Stakeholders’ awareness about long-term opioid therapy is essential for improving the safety and effectiveness of pain treatment. The purpose of this study is to explore the perspectives of pain specialists, patients, and family caregivers about long-term opioid use in CNCP management. Methods This study was a qualitative study and adhered to the COREQ guidelines. Pain specialists (n = 12), patients (n = 14), and family members (n = 9) were recruited to the study by purposive sampling at the Pain Clinic of Ramathibodi Hospital. Semi-structured interviews were recorded, verbatim transcribed, conceptually coded, and analyzed using Atlas.ti 8.0. Results All groups of participants described opioids as non-first-line drugs for pain management. Opioids should be prescribed only for severe pain, when non-opioid pharmacotherapy and non-pharmacological therapies are not effective. Patients reported that the benefits of opioids were for pain relief, while physicians and most family members highlighted that opioid use should improve functional outcomes. Physicians and family members expressed concerns about opioid-related side effects, harm, and adverse events, while patients did not. Patients confirmed that they would continue using opioids for pain management under supervision. However, physicians stated that they would taper off or discontinue opioid therapy if patients’ pain relief or functional improvement was not achieved. Both patients and family members were willing to consider non-pharmacological therapies if potential benefits existed. Patient education, doctor–patient/family relationships, and opioid prescription policies were proposed to enhance CNCP management. Conclusion Long-term opioid therapy for CNCP may be beneficial in patients who have established realistic treatment goals (for both pain relief and functional improvement) with their physicians. Regular monitoring and evaluation of the risks and benefits, adverse events, and drug-related aberrant behaviors are necessary. Integrated multimodal multidisciplinary therapies and family member collaborations are also important for improving CNCP management.

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Effectiveness of Opioids in the Treatment of Chronic Non-Cancer Pain

January 2018 - Pain Physician ◽

10.36076/ppj.2008/11/s181 ◽

2008 ◽

Vol 2s;11 (3;2s) ◽

pp. S181-S200 ◽

Cited By ~ 3

Author(s):

Andrea M. Trescot

Keyword(s):

Side Effects ◽

Pain Relief ◽

Cancer Pain ◽

Opioid Therapy ◽

Psychological Status ◽

Functional Improvement ◽

Transdermal Fentanyl ◽

Chronic Noncancer Pain ◽

Weak Evidence

For thousands of years, opioids have been used to treat pain, and they continue to be one of the most commonly prescribed medications for pain. It is estimated that 90% of patients presenting to pain centers and receiving treatment in such facilities are on opioids. Opioids can be considered broad-spectrum analgesics that act at multiple points along the pain pathway. Unfortunately, opioids also have the potential for great harm, with multiple side effects and potential complications, some of which are lethal. They are also uniquely addictive, which can lead to misuse and diversion. We reviewed the relevant English literature and did thorough manual searches of the bibliographies of known primary and review articles. We utilized pain relief as the primary outcome measure. Other outcome measures were functional improvement, improvement of psychological status, improvement in work status, and evidence of addiction. Shortterm use and improvement was defined as less than 6 months and long-term relief was defined as 6 months or longer. The 3 systematic reviews evaluating long-term effectiveness of opioids for chronic noncancer pain provided unclear and weak evidence. The results of this review showed that many patients in the included studies were dissatisfied with adverse events or insufficient pain relief from opioids and withdrew from the studies. For patients able to continue on opioids, evidence was weak suggesting that their pain scores were lower than before therapy and that this relief could be maintained long-term (> 6 months). There was also weak evidence that long-term opioid therapy with morphine and transdermal fentanyl not only decreases pain but also improves functioning. Limited evidence was available for the most commonly used opioids, oxycodone and hydrocodone. Evidence for the ability to drive on chronic opioid therapy was moderate without major side effects or complications. It is concluded that, for long-term opioid therapy of 6 months or longer in managing chronic non-cancer pain, with improvement in function and reduction in pain, there is weak evidence for morphine and transdermal fentanyl. However, there is limited or lack of evidence for all other controlled substances, including the most commonly used drugs, oxycodone and hydrocodone. Key words: Opioids, opioid effectiveness, pain relief, functional improvement, adverse effects, codeine, morphine, hydrocodone, hydromorphone, fentanyl, methadone.

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