High-dose opioids for chronic non-cancer pain: an overview of Cochrane Reviews

Els, Charl; Jackson, Tanya; Hagtvedt, Reidar; Kunyk, Diane; Sonnenberg, Barend; Lappi, Vernon G; Straube, Sebastian

doi:10.1002/14651858.cd012299.pub3

Cited by 4 publications

(3 citation statements)

References 111 publications

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“…Opioids, like morphine, are often used to help with long-lasting pain in CNCP because they work by targeting specific pain receptors in the body [54]. Their main job is to make pain easier to handle by changing the way the body feels pain, making it seem less intense [55]. The use of opioids for CNCP is widely debated and researched because of safety concerns, even though prescriptions have increased [56][57][58].…”

Section: Adverse Events Of Long-term Opioid Usementioning

confidence: 99%

Adverse Events of the Long-Term Use of Opioids for Chronic Non-cancer Pain: A Narrative Review

Altawili,

Alzarar

et al. 2024

Cureus

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Background: The long-term use of opioids for chronic non-cancer pain (CNCP) has drawn more attention and debate. Although opioids are frequently used to treat chronic pain, their effectiveness and safety over extended periods are still unknown.Objectives: The purpose of this review is to provide an overview of what is currently known about the adverse events of long-term use of opioids in CNCP. It also delivers patient-centered strategies designed to mitigate these risks.Methods: We conducted a literature search in PubMed, MEDLINE, EMBASE, and Web of Science databases. Search terms included CNCP, pain pathophysiology, opioid pharmacodynamics, opioid prescribing trends, guidelines for opioid use, and opioid side effects.Results: Our review highlights that while opioids may provide short-term relief from CNCP, their effectiveness diminishes over time due to the development of opioid tolerance. This tolerance often leads to increased dosages, which can subsequently result in opioid dependence. Additionally, long-term opioid therapy is associated with a spectrum of adverse effects, including constipation, drowsiness, respiratory depression, and potential for drug interactions. Furthermore, our review indicates that alternative pain management strategies play a crucial role in controlling CNCP. They offer significant benefits with fewer adverse events. These strategies include non-opioid medications, physical therapy, cognitive-behavioral therapy (CBT), various interventional procedures, injection therapy, and acupuncture.Conclusion: Using opioids to manage CNCP presents several challenges. Given these challenges, alternative treatments are being considered as viable options. Moreover, it is crucial to customize treatment plans to align with the patients' specific health requirements, existing conditions, and potential risks to ensure the best possible outcomes.

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Section: Adverse Events Of Long-term Opioid Usementioning

confidence: 99%

Adverse Events of the Long-Term Use of Opioids for Chronic Non-cancer Pain: A Narrative Review

Altawili,

Alzarar

et al. 2024

Cureus

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“…Trends of increased chronic prescription opioid use for non-cancer pain raise concerns not only in the United States and Canada but also in European countries [ 1 , 2 ]. Although these drugs are very effective analgesics, especially for cancer pain treatment [ 3 ], the evidence base for their use in (chronic) non-cancer pain is limited [ 4 ]. At present, geographical and practice variations in opioid prescribing are high [ 5 , 6 ], potentially indicating inappropriate use but complicating a thorough evaluation of the exact societal burden.…”

Section: Introductionmentioning

confidence: 99%

Opioid Analgesics after Bariatric Surgery: A Scoping Review to Evaluate Physiological Risk Factors for Opioid-Related Harm

Wuyts

Torensma

Schellekens

et al. 2023

JCM

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The persisting use of opioids following bariatric surgery has emerged as a prevalent complication, heightening the probability of opioid-related harm (ORM), such as opioid-related fatalities and prescription opioid use disorder (OUD). A comprehensive review of PubMed literature from 1990 to 2023 was conducted to pinpoint physiological influences on postoperative ORM. As a result, we found that patients undertaking bariatric operations often exhibit an inherently higher risk for substance use disorders, likely attributable to genetic predisposition and related neurobiological changes that engender obesity and addiction-like tendencies. Furthermore, chronic pain is a common post-bariatric surgery complaint, and the surgical type impacts opioid needs, with increased long-term opioid use after surgeries. Additionally, the subjective nature of pain perception in patients with obesity can distort pain reporting and the corresponding opioid prescription both before and after surgery. Furthermore, the postoperative alterations to the gastrointestinal structure can affect the microbiome and opioid absorption rates, resulting in fluctuating systemic exposure to orally ingested opioids. The prospect of ORM development post-bariatric surgery appears amplified due to a preexisting susceptibility to addictive habits, surgically induced pain, modified gut–brain interaction and pain management and the changed pharmacokinetics post-surgery. Further research is warranted to clarify these potential risk variables for ORM, specifically OUD, in the bariatric population.

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“…Contribution 3 investigated the use of opioids for the management of non-cancer pain. It is a topic of considerable debate and controversy [17]. While these analgesics can provide effective pain relief, they also come with significant risks and potential adverse effects.…”

mentioning

confidence: 99%

Editorial to the Special Issue: “Recent Advances in the Management of Chronic Pain”

Cascella

2023

IJERPH

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High-dose opioids for chronic non-cancer pain: an overview of Cochrane Reviews

Cited by 4 publications

References 111 publications

Adverse Events of the Long-Term Use of Opioids for Chronic Non-cancer Pain: A Narrative Review

Adverse Events of the Long-Term Use of Opioids for Chronic Non-cancer Pain: A Narrative Review

Opioid Analgesics after Bariatric Surgery: A Scoping Review to Evaluate Physiological Risk Factors for Opioid-Related Harm

Editorial to the Special Issue: “Recent Advances in the Management of Chronic Pain”

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