Long-term use of opioids to manage chronic noncancer pain (such as chronic back pain after failed surgery) has been on the rise in the past decade, but so have deaths from opioid overdose and abuse of prescription painkillers. It would be nice to know if chronic opioids do help people who desperately need relief from chronic pain, and what the risk for addiction or abuse is with long-term opioid use.
A new study begins — but only begins — to answer those questions. The Cochrane Collaboration reviewed the medical literature (see my story here) and came away underwhelmed with the small number of studies on long-term opioid use for noncancer pain, and the “crummy” quality of those studies — a description used by one of the pain experts that I interviewed.
The review found that many patients dropped out of studies on long-term opioid use (6%-23%, depending on whether they took opioids orally, transdermally, or intrathecally and whether they dropped out due to lack of pain relief or side effects). Most of the studies excluded patients with a history of drug abuse or addiction.
In those who finished the studies — a very select group at this point — chronic opioids continued to provide significant pain relief up to 48 months after starting therapy, and only 0.03% showed signs of addiction or took the drugs inappropriately. So many caveats were attached to the findings that it’s still unclear what many of the long-term effects may be. What about how the patient functions? Quality of life? Effects on patients who stop opioid therapy? Or use in the kinds of patients that worry clinicians when considering prescribing opioids for chronic noncancer pain–those who have psychiatric comorbidities or substance abuse issues, young patients, or those with ill-defined pain syndromes?
I foresee a lot of research ahead on improving and maximizing long-term use of opioids for chronic pain. As Dr. Perry Fine, president-elect of the American Academy of Pain Medicine, said, the study is “very encouraging, but it’s far from the whole story.”
–Sherry Boschert (@sherryboschert on Twitter)