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

Abstract

The Agency for Healthcare Research and Quality (AHRQ), through its Evidencebased Practice Centers (EPCs), sponsors the development of evidence reports and technology assessments to assist publicand private-sector organizations in their efforts to improve the quality of health care in the United States. The reports and assessments provide organizations with comprehensive, science-based information on common, costly medical conditions and new health care technologies. The EPCs systematically review the relevant scientific literature on topics assigned to them by AHRQ and conduct additional analyses when appropriate prior to developing their reports and assessments. AHRQ expects that the EPC evidence reports and technology assessments will inform individual health plans, providers, and purchasers as well as the health care system as a whole by providing important information to help improve health care quality. The full report and this summary are available at www.effectivehealthcare.ahrq. gov/reports/final.cfm. d. In patients with chronic pain, what is the comparative effectiveness of opioids plus nonopioid interventions (pharmacological or nonpharmacological) versus opioids or nonopioid interventions alone on outcomes related to pain, function, quality of life, and doses of opioids used? Key Question 2. Harms and Adverse Events a. In patients with chronic pain, what are the risks of opioids versus placebo or no opioid on: (1) opioid abuse, addiction, and related outcomes; (2) overdose; and (3) other harms, including gastrointestinal-related harms, falls, fractures, motor vehicle accidents, endocrinological harms, infections, cardiovascular 3 events, cognitive harms, and psychological harms (e.g., depression)? b. How do harms vary depending on: (1) the specific type or cause of pain (e.g., neuropathic, musculoskeletal [including back pain], fibromyalgia, sickle cell disease, inflammatory pain, headache disorders); (2) patient demographics; (3) patient comorbidities (including past or current substance use disorder or at high risk for addiction); (4) the dose of opioids used? Key Question 3. Dosing Strategies

CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016

“…A previously published systematic review sponsored by the Agency for Healthcare Research and Quality (AHRQ) on the effectiveness and risks of long-term opioid treatment of chronic pain (14,52) initially served to directly inform the recommendation statements. This systematic clinical evidence review addressed the effectiveness of long-term opioid therapy for outcomes related to pain, function, and quality of life; the comparative effectiveness of different methods for initiating and titrating opioids; the harms and adverse events associated with opioids; and the accuracy of risk-prediction instruments and effectiveness of risk mitigation strategies on outcomes related to overdose, addiction, abuse, or misuse.…”

“…Evidence supports short-term efficacy of opioids for reducing pain and improving function in noncancer nociceptive and neuropathic pain in randomized clinical trials lasting primarily ≤12 weeks (9,10), and patients receiving opioid therapy for chronic pain report some pain relief when surveyed (11)(12)(13). However, few studies have been conducted to rigorously assess the long-term benefits of opioids for chronic pain (pain lasting >3 months) with outcomes examined at least 1 year later (14). On the basis of data available from health systems, researchers estimate that 9.6-11.5 million adults, or approximately 3%-4% of the adult U.S. population, were prescribed long-term opioid therapy in 2005 (15).…”

Morphine paradoxically prolongs neuropathic pain in rats by amplifying spinal NLRP3 inflammasome activation

“…TLR4 | P2X7R | danger signals | DAMP | opioid-induced hyperalgesia R ecent reports are critical of the lack of controlled, long-term studies to support the dramatic escalation of opioid treatment for chronic pain over the past decade (1)(2)(3)(4)(5). Although one long-term concern is that there may be no benefit, another is that opioid treatment could have negative consequences for pain.…”

The Short-Term Effects of a Single Lecture on Undergraduate Physiotherapy Students' Understanding Regarding Pain Neurophysiology: A Prospective Case Series

“…Based on the positive findings of their study and our study, the current education regarding pain science for Japanese physiotherapy students should be reconsidered. As mentioned in the introduction section, some types of patient education based on biomedical models can affect patients' longterm prognosis negatively [20][21][22][23][24]. On the other hand, there is growing evidence suggesting the effectiveness of pain neurophysiology education based on biopsychosocial model for patients with chronic pain [17][18][19].…”

“…In fact, this educational approach has been proven to be effective in decreasing pain and improving the physical function in patients with chronic pain conditions [17][18][19]. On the other hand, some studies implied that biomedical-driven excessive imaging, treatments and patient's education can potentially reinforce patients' maladaptive thinking and behaviours, leading to iatrogenic chronic pain states [20][21][22][23][24].…”