How effective is long-term opioid therapy for chronic pain?
The jury is still out on this one…
Recently, the National Institutes of Health (NIH) commissioned the Agency for Healthcare Research and Quality (AHRQ) to conduct a systematic review* of the current evidence on long-term opioid therapy for chronic pain. The results were used to inform the NIH workshop, Pathways to Prevention: The Role of Opioids in the Treatment of Chronic Pain. A key finding of the AHRQ report was that the confidence level in the efficacy of long-term therapy was ranked “no higher than low” due to methodological shortcomings and imprecision.
Other findings of the report were that:
- Long-term opioid therapy was associated with increased risk of abuse, overdose, fracture, myocardial infarction, and markers of sexual dysfunction, with several studies showing a dose-dependent association.
Methodological shortcomings—such as varied definitions and measures—made it difficult to draw conclusions, as shown by:
- In 10 uncontrolled studies, rates of opioid abuse were 0.6-8% and rates of dependence were 3-26% in primary care settings, but definitions and measures varied.
- Rates of aberrant drug-related behaviors ranged from 5-37%.
- To date, no study has evaluated effects of long-term opioid therapy versus no opioid therapy.
*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 Treatment of Chronic Pain. Evidence Report/Technology Assessment No. 218. (Prepared by 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 Research and Quality; September 2014.