Abstract
ABSTRACT Objective The objective of this study was to investigate in a real-life context the effectiveness of long-term opioid therapy for reducing pain intensity and interference and improving health-related quality of life (QOL) in patients with chronic noncancer pain. Methods Participants were 893 patients (age = 52.4 ± 14.1, female = 62.4%) enrolled in the Quebec Pain Registry (2008–2011) who completed questionnaires before their first visit at one of three multidisciplinary pain management clinics and 6 and 12 months thereafter. Based on their opioid use profile (OUP), patients were categorized as nonusers, non-lasting users, or lasting users. Data were analyzed using generalized estimating equations. Results More than 60% of patients newly initiated on opioid therapy stopped their medication mainly because of adverse effects and/or lack of pain relief. OUP significantly predicted pain intensity and interference and physical QOL (pQOL; P values < 0.001). Lasting users of opioids reported higher levels of pain intensity and interference and poorer pQOL than nonusers and/or non-lasting users over the 12-month follow-up (P values < 0.001). However, all effect sizes were small, thus questioning the clinical significance of these group differences. Among lasting users, more than 20% of patients experienced a meaningful amelioration in pain intensity and interference as well as mental QOL (mQOL), whereas only 8% exhibited improved pQOL. Discussion A significant subgroup of patients may benefit from long-term opioid therapy in terms of pain severity and mQOL but the majority do not. The challenge facing clinicians is how to identify who the responders will be.
Highlights
In Canada and the United states, opioids are among the most widely used drugs to treat chronic noncancer pain (CNCP) along with acetaminophen and nonsteroidal anti-inflammatory drugs.[1,2,3] Opioids are potent analgesics, but their use is associated with several side effects such as respiratory depression, nausea, or constipation.[4]
A total of 2650 patients were enrolled in the Quebec Pain Registry (QPR) during the selected study period and consented for their information to be used for research purposes
PQOL improved from baseline to 12 months among only 8% of the lasting users. This multicenter study is the first to have examined the effectiveness of long-term opioid therapy for reducing pain severity and improving health-related quality of life (QOL) in a large heterogeneous sample of patients with CNCP newly initiated on this type of treatment and followed in a real-life context
Summary
In Canada and the United states, opioids (e.g., morphine, oxycodone, fentanyl) are among the most widely used drugs to treat chronic noncancer pain (CNCP) along with acetaminophen and nonsteroidal anti-inflammatory drugs.[1,2,3] Opioids are potent analgesics, but their use is associated with several side effects such as respiratory depression, nausea, or constipation.[4]. A literature review published in 2009 by the American Pain Society in collaboration with the American Academy of Pain Medicine found that very few studies have investigated the long-term benefits of opioids (≥6 months) in CNCP,[14] among which two high-quality systematic reviews found that opioids were discontinued by a high proportion of patients due to adverse events or insufficient pain relief.[15,16] Noble et al concluded that only weak evidence supports the fact that patients who are able to continue opioids on a longterm basis experience clinically significant pain relief, though the evidence for improvement in healthrelated quality of life and physical functioning is inconclusive.[16] The most recent literature review published in 2015 came to similar conclusions.[12] To date, research on pharmacological agents for chronic pain management has been limited mainly to clinical trials, which are often of short duration and have stringent selection criteria.[17,18,19] Furlan et al reported that 74% of randomized clinical trials on opioid therapy had a duration of less than 6 weeks.[20] Some cross-sectional studies have evaluated the effectiveness of long-term opioid therapy for improving pain severity and/or quality of life among patients with
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