Long‐term opioid therapy in Denmark: A disappointing journey

Abstract

Long-term opioid therapy does not seem to provide pain relief, improvement in HRQOL and physical capacity in CNCP patients in a general population.

Tapering off long‐term opioid therapy in chronic non‐cancer pain patients: A randomized clinical trial

“…However, there is still a lack of information regarding efficacy on L‐TOT (Dowell et al., ). Epidemiological studies of the Danish population have demonstrated that L‐TOT for CNCP did not provide advantages regarding pain control, quality of life and functional capacity (Eriksen et al., ; Birke et al., ). Moreover, relationships between duration of opioid treatment and the risk of deleterious effects on work and other activities (Birke et al., ), as well numerous adverse effects of L‐TOT, have been discussed (Kurita and Sjøgren, ).…”

“…Epidemiological studies of the Danish population have demonstrated that L‐TOT for CNCP did not provide advantages regarding pain control, quality of life and functional capacity (Eriksen et al., ; Birke et al., ). Moreover, relationships between duration of opioid treatment and the risk of deleterious effects on work and other activities (Birke et al., ), as well numerous adverse effects of L‐TOT, have been discussed (Kurita and Sjøgren, ). Unfortunately, the low capacity of multidisciplinary pain centres and the high prevalence of CNCP in Denmark (Kurita et al., ) preclude most patients with CNCP from being referred and typically only patients with complex pain conditions and/or patients with problematic opioid use are admitted to specialized treatment.…”

Analgesic consumption trajectories in 8975 patients 1 year after fast‐track total hip or knee arthroplasty

“…Although total hip and knee arthroplasty (THA/TKA) are performed to relieve pain and regain function, treatment failure resulting in persistent pain occurs in 10–20% of patients (Braden et al., ; Beswick et al., ; Lewis et al., ; Lenguerrand et al., ). This may subsequently lead to increased consumption of opioids and other analgesics, with associated risk of adverse effects (Cozowicz et al., ) including endocrine dysfunction (Bawor et al., ), cognitive impairment (Katz and Mazer, ), addiction (Kharasch and Brunt, ), tolerance (Birke et al., ) and a general increased risk of morbidity (Lanas and Sopena, ; Kuo et al., ; Bawor et al., ; Ravel et al., ) and mortality (Ekholm et al., ; Birke et al., ; Rudd et al., ; Sondergaard et al., ). Despite the well‐documented risk for persistent pain (Wylde et al., ; Lewis et al., ; Lenguerrand et al., ) and associated risk of analgesic use, only a limited number of large‐scale studies have investigated opioid consumption after primary THA (Blagestad et al., ; Inacio et al., ; Namba et al., ) or TKA (Fuzier et al., ; Goesling et al., ; Bedard et al., ; Hansen et al., ), and few have included data on non‐opioid analgesic use (Fuzier et al., ; Blagestad et al., ).…”

“…Nonetheless, the findings of continued and increased opioid consumption after THA and TKA concerning, as the surgical procedures are aimed at providing pain relief. Especially considering the above mentioned side effects of chronic opioid treatment as well as the potentially reduced analgesic efficacy over time (McAlindon et al., ; Birke et al., ).…”

National trends in long‐term use of prescription opioids

“…There are indications that the growing trend in overall prescription and use of opioid medications has been associated with an even faster growing trend in long‐term use of these medications, at least in the first half of the last decade . While there is little research on potential benefits and harms of long‐term use of opioids, available data suggest that long‐term use of these medications may be associated with opioid misuse . These concerns are reflected in practice guidelines for management of pain published in recent years .…”