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      Comparison of the Clinical Outcomes between Short-term and Long-term Opioid Users with Noncancer Pain at Pain Clinics

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      Journal of Pharmacy & Bioallied Sciences
      Wolters Kluwer - Medknow
      Noncancer pain, opioids, pain, pain management

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          A BSTRACT

          Introduction:

          The clinical use of opioids for long-term for noncancer pain indications remains a controversy. More studies are needed for evidence-based guidelines in noncancer pain management involving opioids. The primary objective of this study was to investigate the clinical outcomes of the short-term and long-term opioid use among patients with noncancer pain.

          Materials and Methods:

          This is a retrospective cross-sectional study where patients (aged ≥18 years) with noncancer pain treated with opioids were recruited from three pain clinics in Malaysia. Data on patients’ opioid use were collected from prescription records. The individual days covered with opioids per patient were calculated and based on this, patients were classified as short-term (<90 days) or long-term (≥90 days) opioid user. Outcome measures included pain intensity and pain interference with daily activities assessed by Brief Pain Inventory – Short Form (BPI-SF), health-related quality of life (HRQoL) assessed by 36-Item Short Form Health Survey version 2 (SF-36v2). These measures were compared between short-term and long-term opioid users.

          Results:

          Of the 61 noncancer pain patients recruited, 49.2% ( n = 30/61) were short-term and 50.8% ( n = 31/61) were long-term opioid users. There were no statistically significant differences in the mean scores of pain intensity, pain interference with daily activities, and HRQoL between short-term and long-term opioid users in this study.

          Conclusion:

          Findings of this study imply that long-term opioid therapy does not provide significant pain relief or improvement in patients’ functional capability and HRQoL in noncancer pain patients. Future prospective studies with larger sample sizes are needed to support the findings of this study.

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          Most cited references17

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          The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop.

          Increases in prescriptions of opioid medications for chronic pain have been accompanied by increases in opioid overdoses, abuse, and other harms and uncertainty about long-term effectiveness.
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            Long-term opioid management for chronic noncancer pain.

            Opioid therapy for chronic noncancer pain (CNCP) is controversial due to concerns regarding long-term effectiveness and safety, particularly the risk of tolerance, dependence, or abuse. To assess safety, efficacy, and effectiveness of opioids taken long-term for CNCP. We searched 10 bibliographic databases up to May 2009. We searched for studies that: collected efficacy data on participants after at least 6 months of treatment; were full-text articles; did not include redundant data; were prospective; enrolled at least 10 participants; reported data of participants who had CNCP. Randomized controlled trials (RCTs) and pre-post case-series studies were included. Two review authors independently extracted safety and effectiveness data and settled discrepancies by consensus. We used random-effects meta-analysis' to summarize data where appropriate, used the I(2) statistic to quantify heterogeneity, and, where appropriate, explored heterogeneity using meta-regression. Several sensitivity analyses were performed to test the robustness of the results. We reviewed 26 studies with 27 treatment groups that enrolled a total of 4893 participants. Twenty five of the studies were case series or uncontrolled long-term trial continuations, the other was an RCT comparing two opioids. Opioids were administered orally (number of study treatments groups [abbreviated as "k"] = 12, n = 3040), transdermally (k = 5, n = 1628), or intrathecally (k = 10, n = 231). Many participants discontinued due to adverse effects (oral: 22.9% [95% confidence interval (CI): 15.3% to 32.8%]; transdermal: 12.1% [95% CI: 4.9% to 27.0%]; intrathecal: 8.9% [95% CI: 4.0% to 26.1%]); or insufficient pain relief (oral: 10.3% [95% CI: 7.6% to 13.9%]; intrathecal: 7.6% [95% CI: 3.7% to 14.8%]; transdermal: 5.8% [95% CI: 4.2% to 7.9%]). Signs of opioid addiction were reported in 0.27% of participants in the studies that reported that outcome. All three modes of administration were associated with clinically significant reductions in pain, but the amount of pain relief varied among studies. Findings regarding quality of life and functional status were inconclusive due to an insufficient quantity of evidence for oral administration studies and inconclusive statistical findings for transdermal and intrathecal administration studies. Many patients discontinue long-term opioid therapy (especially oral opioids) due to adverse events or insufficient pain relief; however, weak evidence suggests that patients who are able to continue opioids long-term experience clinically significant pain relief. Whether quality of life or functioning improves is inconclusive. Many minor adverse events (like nausea and headache) occurred, but serious adverse events, including iatrogenic opioid addiction, were rare.
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              Critical issues on opioids in chronic non-cancer pain: an epidemiological study.

              The aim of the study was epidemiologically to evaluate the long-term effects of opioids on pain relief, quality of life and functional capacity in long-term/chronic non-cancer pain. The study was based on data from the 2000 Danish Health and Morbidity Survey. As part of a representative National random sample of 16,684 individuals (>16 years of age), 10,066 took part in an interview and completed a self-administered questionnaire. Cancer patients were excluded. The interview and the self-administered questionnaire included questions on chronic/long-lasting pain (>6 months), health-related quality of life (SF-36), use of the health care system, functional capabilities, satisfaction with medical pain treatment and regular or continuous use of medications. Participants reporting pain were divided into opioid and non-opioid users. The analyses were adjusted for age, gender, concomitant use of anxiolytics and antidepressants and pain intensity. Pain relief, quality of life and functional capacity among opioid users were compared with non-opioid users. Opioid usage was significantly associated with reporting of moderate/severe or very severe pain, poor self-rated health, not being engaged in employment, higher use of the health care system, and a negative influence on quality of life as registered in all items in SF-36. Because of the cross-sectional nature causative relationships cannot be ascertained. However, it is remarkable that opioid treatment of long-term/chronic non-cancer pain does not seem to fulfil any of the key outcome opioid treatment goals: pain relief, improved quality of life and improved functional capacity.
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                Author and article information

                Journal
                J Pharm Bioallied Sci
                J Pharm Bioallied Sci
                JPBS
                Journal of Pharmacy & Bioallied Sciences
                Wolters Kluwer - Medknow (India )
                0976-4879
                0975-7406
                November 2020
                05 November 2020
                : 12
                : Suppl 2
                : S728-S732
                Affiliations
                [1]Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia (IIUM), Kuantan, Pahang, Malaysia
                Author notes
                Address for correspondence: Assoc. Prof. Dr. Che Suraya Zin, Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia (IIUM), Kuantan Campus, Indera Mahkota, 25200 Kuantan, Pahang, Malaysia. E-mail: chesuraya@ 123456iium.edu.my
                Article
                JPBS-12-728
                10.4103/jpbs.JPBS_284_19
                8021069
                f4b69684-66f8-4e46-b1d1-92d6a795203e
                Copyright: © 2020 Journal of Pharmacy and Bioallied Sciences

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : 08 November 2019
                : 09 March 2020
                : 21 April 2020
                Categories
                Original Article

                Pharmacology & Pharmaceutical medicine
                noncancer pain,opioids,pain,pain management
                Pharmacology & Pharmaceutical medicine
                noncancer pain, opioids, pain, pain management

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