The effects of long‐term opioid treatment on the immune system in chronic non‐cancer pain patients: A systematic review

Diasso, Pernille D. K.; Birke, Hanne; Nielsen, Susanne Dam; Main, Katharina M.; Højsted, Jette; Sjögren, Per; Kurita, Geana Paula

doi:10.1002/ejp.1506

Cited by 29 publications

(25 citation statements)

References 45 publications

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“…with variable results on perceived pain [ 7 , 8 , 9 ]. Despite these promising results, research has suggested that 64% of patients with persistent pain feel that remaining on opioid medications are worth the risk of harm (e.g., potential impact on immune system) [ 39 , 40 ]. This belief may hinder implementation of alternative pain management methods such as exercise and meditation that were recommended by pharmacists during this study.…”

Section: Discussionmentioning

confidence: 99%

The Impact of a Primary Care, Pharmacist-Driven Intervention in Patients with Chronic Non-Cancer Pain—A Pilot Study

2020

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Background: Chronic pain is a prevalent condition, experienced by 15.3% to 55% of Canadians, that is difficult to manage. With their broad accessibility and expertise on drugs, primary care pharmacists can help patients optimize their pain management. Methods: The objective of this study is to examine the effectiveness of a primary care, pharmacist-driven chronic pain intervention on pain and quality of life in patients with chronic non-cancer pain. A three-month naturalistic prospective study was conducted in primary care settings (five community pharmacies and one Family Health Team) across Ontario, Canada with a total of six pharmacists and 19 study participants. The primary care, pharmacist-driven chronic pain intervention consisted of patient assessments, medication reviews, care plan recommendations, and patient education. In order to evaluate the effectiveness of the intervention, pain intensity, pain interference, and quality of life were evaluated at baseline and at follow up (week 2 and month 3). Results: Trends towards improvement in pain and quality of life were found, however, these improvements were not statistically significant at follow up (month 3). Conclusions: This study provides the foundational research required to better understand the impact of Ontario pharmacists’ extended role in pain management in non-cancer patients within multiple primary care settings (e.g., Family Health Team, etc.) and has illustrated the importance of modifying and customizing care plans in patients with chronic pain. A larger sample size with tailored outcome measures may be necessary to better highlight significant improvements in pain and quality of life in patients with chronic non-cancer pain using a primary care, pharmacist-driven intervention.

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Section: Discussionmentioning

confidence: 99%

The Impact of a Primary Care, Pharmacist-Driven Intervention in Patients with Chronic Non-Cancer Pain—A Pilot Study

2020

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“…For example, if more MCP in women is associated with immune function, drugs that influence this may have specific long-term effects (positive or negative) in women and not in men. Opioids are known to adversely affect immune function (105,106). These differences may also inform the search for new, or re-purposed drugs in a sex specific manner, building on animal studies where specific proteins have been found to play sex-specific roles in pain processing, and certain drugs have been found to have sex-specific effects in terms of analgesia (reviewed by (107)).While there are clearly also many similarities, it is important that clinicians begin to recognize these differences in clinical assessment and awareness of risks.…”

Section: Discussionmentioning

confidence: 99%

Sex-Stratified Genome-Wide Association Study of Multisite Chronic Pain in UK Biobank

Johnston

Ray

Adams

et al. 2020

Preprint

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Chronic pain is highly prevalent worldwide and imparts significant socioeconomic and public health burden and is more prevalent in women than in men. Factors that influence susceptibility and mechanisms of chronic pain development, are not fully understood. To investigate sex differences in chronic pain, we carried out a sex-stratified genome-wide association study of Multisite Chronic Pain (MCP), a derived chronic pain phenotype in UK Biobank. Genetic correlations between MCP in each sex and a range of psychiatric, autoimmune, and anthropometric phenotypes were examined. The relationship between female and male MCP, and chronic widespread pain was investigated using polygenic risk scoring. Expression of sex-specific MCP-associated loci in a range of tissues was examined using GTEx, and separately in neural and non-neural human tissues with assessment for dorsal-root ganglion (DRG) enrichment. For genes enriched for neural-tissue expression the full GTEx database was queried for sex-differential gene expression in CNS regions, and for high expression in sex-specific tissues. Expression in neural mouse tissue was also examined for orthologs of these genes. A total of 123 SNPs at five independent loci were significantly associated with MCP in men. In women, a total of 286 genome-wide significant SNPs at ten independent loci were discovered. Meta-analysis of sex-stratified GWAS output found 87 independent SNPs to be significantly associated with MCP. We found sex-specific MCP-associated genes, with 31 genes and 37 genes associated with female and male MCP respectively and one gene associated with MCP in both sexes (DCC). We found evidence for sex-specific pleiotropy and risk for MCP was found to be associated with chronic widespread pain in a sex-differential manner. Male and female MCP were highly genetically correlated, but at rg significantly less than 1. All 37 male MCP-associated genes and all but one of 31 female MCP-associated genes were found to be expressed in the DRG, and many showed elevated expression in sex-specific tissues. Overall, findings indicate sex differences in chronic pain at the SNP, gene and transcriptomic level, and highlight possible sex-specific pleiotropy for MCP. Results support the proposition of a strong nervous-system component to chronic pain in both sexes, emphasise the importance of the DRG, and indicate specific loci which may play a specialised role in nociception.

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“…A variety of opioid receptor acting drugs are currently FDA‐approved in the US with a vast number of immunologic actions (Table 1). 16,17 …”

Section: Methodsmentioning

confidence: 99%

The immunomodulatory effects of opioids and implications for intensive care unit populations

2021

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Analgesia within the intensive care unit (ICU) is often achieved via the utilization of opioids in alignment with current guidelines. Recent evidence has not only demonstrated the potential impact of opioids in suppression of immune function, but also the potential harm of immunosuppression of patients within the ICU. Despite the potential immunosuppression seen with opioids in this at‐risk population, their use remains frequent. In this review, we highlight the potential immunomodulatory impact of opioids within the critically ill and considerations for their use.

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The effects of long‐term opioid treatment on the immune system in chronic non‐cancer pain patients: A systematic review

Cited by 29 publications

References 45 publications

The Impact of a Primary Care, Pharmacist-Driven Intervention in Patients with Chronic Non-Cancer Pain—A Pilot Study

The Impact of a Primary Care, Pharmacist-Driven Intervention in Patients with Chronic Non-Cancer Pain—A Pilot Study

Sex-Stratified Genome-Wide Association Study of Multisite Chronic Pain in UK Biobank

The immunomodulatory effects of opioids and implications for intensive care unit populations

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