The Effectiveness and Risks of Long-Term Opioid Treatment of Chronic Pain

Systematic Review ARCHIVED Sep 29, 2014

Related Files

People using assistive engineering science may not be able to fully access data in these files. For additional assist, please contact us.

Archived : This written report is greater than 3 years sometime. Findings may be used for inquiry purposes, merely should non be considered electric current.

Structured Abstract

Objectives

Chronic pain is common and utilise of long-term opioid therapy for chronic pain has increased dramatically. This study reviews the current testify on effectiveness and harms of opioid therapy for chronic pain, focusing on long-term (≥1 year) outcomes.

Data sources

A prior systematic review (searches through October 2008), electronic databases (Ovid MEDLINE, Scopus, and the Cochrane Libraries January 2008 to August 2014), reference lists, and clinical trials registries.

Review methods

Using predefined criteria, nosotros selected randomized trials and comparative observational studies of patients with cancer or noncancer chronic pain being considered for or prescribed long-term opioid therapy that addressed effectiveness or harms versus placebo, no opioid apply, or nonopioid therapies; dissimilar opioid dosing methods; or risk mitigation strategies. We as well included uncontrolled studies ≥1 year that reported rates of abuse, addiction, or misuse, and studies on the accuracy of risk prediction instruments for predicting subsequent opioid abuse or misuse. The quality of included studies was assessed, data were extracted, and results were summarized qualitatively.

Results

Of the iv,209 citations identified at the championship and abstract level, a total of 39 studies were included. For a number of Central Questions, we identified no studies meeting inclusion criteria. Where studies were available, the force of evidence was rated no higher than depression, due to imprecision and methodological shortcomings, with the exception of buccal or intranasal fentanyl for pain relief outcomes inside 2 hours afterwards dosing (force of evidence: moderate). No study evaluated effects of long-term opioid therapy versus no opioid therapy. In ten uncontrolled studies, rates of opioid abuse were 0.6 percentage to 8 percent and rates of dependence were three.ane percentage to 26 percent in main care settings, but studies varied in methods used to ascertain and ascertain outcomes. Rates of aberrant drug-related behaviors ranged from 5.7 percent to 37.1 percent. Compared with nonuse, long-term opioid therapy was associated with increased risk of corruption (one cohort study), overdose (one cohort written report), fracture (two observational studies), myocardial infarction (two observational studies), and markers of sexual dysfunction (one cross-sectional study), with several studies showing a dose-dependent clan. One randomized trial institute no deviation betwixt a more liberal opioid dose escalation strategy and maintenance of current dose in pain or function, only differences between groups in daily opioid doses at the cease of the trial were small-scale. Ane accomplice study found methadone associated with lower risk of mortality than long-acting morphine in a Veterans Affairs population in a propensity adjusted analysis (adjusted Hr 0.56, 95 percent CI 0.51 to 0.62). Estimates of diagnostic accuracy for the Opioid Risk Tool were extremely inconsistent and other risk assessment instruments were evaluated in simply one or two studies. No written report evaluated the effectiveness of risk mitigation strategies on outcomes related to overdose, addiction, abuse, or misuse. Evidence was bereft to evaluate benefits and harms of long-term opioid therapy in high-risk patients or in other subgroups.

Conclusions

Evidence on long-term opioid therapy for chronic pain is very limited but suggests an increased gamble of serious harms that appears to be dose-dependent. More research is needed to understand long-term benefits, gamble of abuse and related outcomes, and effectiveness of different opioid prescribing methods and run a risk mitigation strategies.

Commendation

Chou R, Deyo R, Devine B, Hansen R, Sullivan S, Jarvik JG, Blazina I, Dana T, Bougatsos C, Turner J. The Effectiveness and Risks of Long-Term Opioid Handling of Chronic Pain. Prove Written report/Technology Cess No. 218. (Prepared past the Pacific Northwest Evidence-based Practice Center under Contract No. 290-2012-00014-I.) AHRQ Publication No. 14-E005-EF. Rockville, MD: Agency for Healthcare Inquiry and Quality; September 2014. www.effectivehealthcare.ahrq.gov/reports/terminal.cfm. DOI: https://doi.org/10.23970/AHRQEPCERTA218.

Project Timeline

The Effectiveness and Risks of Long-Term Opioid Treatment of Chronic Pain

December xix, 2013

Topic Initiated

Sep 29, 2014

Systematic Review Archived

You Might Too Like

  • Systematic Review

    Feb 10, 2022

  • Research Protocol

    November ten, 2020

  • Research Protocol

    January 02, 2020

  • Inquiry Protocol

    Feb 27, 2019

  • Research Protocol

    Apr 27, 2017

Folio last reviewed December 2019

Page originally created November 2017

Cyberspace Citation: Systematic Review: The Effectiveness and Risks of Long-Term Opioid Treatment of Chronic Pain. Content last reviewed Dec 2019. Effective Health Care Plan, Agency for Healthcare Research and Quality, Rockville, MD.
https://effectivehealthcare.ahrq.gov/products/chronic-pain-opioid-handling/research

Select to copy citation