Abstract
Objectives: To determine the prevalence and factors associated with the use of opioids among patients with chronic non-cancer pain (CNCP). Methods: A systematic review and meta-analysis. Comprehensive literature searches in Medline-PubMed, Embase and SCOPUS databases. Original studies published between 2009 and 2019 with a cross-sectional design were included. The quality of the studies was assessed with Critical Appraisal Checklist for Studies Reporting Prevalence Data from the Joanna Briggs Institute. Protocol registered in the International Prospective Register of Systematic Reviews with reference number: CRD42019137990. Results: Out of the 1,310 potential studies found, 25 studies fulfilled the inclusion criteria. Most of the studies were of high quality. High levels of heterogeneity were found in the studies included. In the general population, the prevalence of long-term opioid use was 2.3% (95% CI: 1.5–3.6%), the prevalence of short-term opioid use was 8.1% (95% CI: 5.6–11.6%), and among people with chronic low back pain it was 5.8% (95% CI: 0.5–45.5%). The prevalence of opioid use among patients from the health records or medical surveys was 41% (95% CI: 23.3–61.3%). Finally, in patients with musculoskeletal pain, the prevalence was 20.5% (95% CI: 12.9–30.9%) and in patients with fibromyalgia, 24.5% (95% CI: 22.9–26.2%). A higher prevalence of opioid use was observed among men, younger people, patients receiving prescriptions of different types of drugs, smokers and patients without insurance or with noncommercial insurance. In addition, non-white and Asian patients were less likely to receive opioids than non-Hispanic white patients. Conclusions: The prevalence of opioid use among patients with CNCP was higher in subjects with short or occasional use compared to those with long-term use. Men, younger people, more chronic pain conditions, and patients without insurance or with noncommercial insurance were most related to opioid use. However, non-white and Asian patients, and those treated by a physician trained in complementary medicine were less likely to use opioids.
Highlights
Chronic pain (CP) is a major public health concern (Vos et al, 2012) that is associated with disability, distress, and a decrease in the quality of life of affected individuals (de Sola et al, 2016)
The prevalence of long-term opioid use was 2.3%, the prevalence of short-term opioid use was 8.1%, and among people with chronic low back pain it was 5.8%
The prevalence of opioid use among patients with cancer pain (CNCP) was higher in subjects with short or occasional use compared to those with long-term use
Summary
Chronic pain (CP) is a major public health concern (Vos et al, 2012) that is associated with disability, distress, and a decrease in the quality of life of affected individuals (de Sola et al, 2016). Opioid therapy has attracted growing interest recently related to the increased use observed in CP patients (Cheung et al, 2014; Alam and Juurlink, 2015; Webster et al, 2017). This situation is of particular concern in patients with chronic non-cancer pain (CNCP), where the evidence of opioid therapy benefits may be less robust than that observed in patients with acute or cancer pain (Von Korff et al, 2011; Scholten, 2013; Campbell et al, 2015). The duration of opioid therapy is important with regard to the benefits for patients, since the prescription of opioids may be appropriate for short-term pain relief, but long-term opioid therapy (LTOT) cannot be associated with improvements in pain or function (Karmali et al, 2020)
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