Abstract
Purpose: To guide clinicians in balancing the risks and benefits of opioids when treating pain, we conducted two systematic reviews: 1) the impact of pain on cognitive function, and 2) the impact of opioids on cognitive function.Methods: Part one addressed the impact of pain on cognitive impairment; Part two considered the impact of opioids on cognitive impairment. PubMed was used to search for eligible articles. For part one, 1786 articles were identified, of which 23 met our eligibility criteria. For part two, among 584 articles, 18 were found eligible.Results: For part one, 16 studies concluded that patients with chronic pain showed impaired cognitive function; six studies found that chronic pain does not worsen cognitive function; one study concluded that the impact of pain on cognitive function differs based on the underlying cognitive status. For part two, 15 studies found that using opioids to control pain did not cause significant cognitive impairment, while three studies concluded the opposite. Studies evaluating older subjects did not observe different results from those in the whole population for both reviews.Conclusion: The published literature indicates that moderate to severe pain can impair cognitive function, and that careful use of opioid analgesics in such subjects does not necessarily worsen cognition. Although our results are insufficient to support clear guidance due to heterogeneity of cohorts and outcomes, this study may assist primary care providers by rendering explicitly the factors to be considered by providers caring for this population with pain when opioids are considered.
Highlights
BackgroundThe opioid crisis is a nationwide concern
Articles focusing on the outcome of neuropsychological conditions, such as delirium, agitation, were excluded, as we focused on long-term impairment of cognitive function, rather than transient or short-term complications
Sixteen out of 23 reviewed studies concluded that patients with chronic pain have worse cognitive function than patients without pain
Summary
The opioid crisis is a nationwide concern. The use of opioids is frequently considered when other treatment modalities fail to manage pain [1]. One of the main concerns related to opioids is cognitive impairment [2], especially, for the frail elderly population [3]. It recommends providers to avoid using opioids except for pain management in the setting of severe acute pain, such as recent fractures or joint replacement. As this is a rather general statement, it is desirable to have a more practical, evidence-based recommendation
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