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

Background: 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.

Purpose: To evaluate evidence on the effectiveness and harms of long-term (>3 months) opioid therapy for chronic pain in adults…

Data Synthesis: No study of opioid therapy versus no opioid therapy evaluated long-term (>1 year) outcomes related to pain, function, quality of life, opioid abuse, or addiction. Good- and fair-quality observational studies suggest that opioid therapy for chronic pain is associated with increased risk for overdose, opioid abuse, fractures, myocardial infarction, and markers of sexual dysfunction, although there are few studies for each of these outcomes; for some harms, higher doses are associated with increased risk. Evidence on the effectiveness and harms of different opioid dosing and risk mitigation strategies is limited.

Limitations: Non–English-language articles were excluded, meta-analysis could not be done, and publication bias could not be assessed. No placebo-controlled trials met inclusion criteria, evidence was lacking for many comparisons and outcomes, and observational studies were limited in their ability to address potential confounding.

Conclusion: Evidence is insufficient to determine the effectiveness of long-term opioid therapy for improving chronic pain and function…

Disclosures:  Dr. Chou reports grants from the Agency for Healthcare Research and Quality during the conduct of the study and consultancies for the U.S. Department of Health and Human Services, the Physicians’ Clinical Support System for Opioids (funded by the Substance Abuse and Mental Health Services Administration), the Mayday Foundation, the Collaborative Opioid Prescribing Education for REMS (funded by the University of Washington)…

Donaghue and Mayday’s co-funded research grant supports a team of researchers and clinicians led by Robert Kerns, PhD who are testing the implementation of a stepped-model of pain management that will improve skills needed to treat pain at the primary care level; the research is being conducted with veterans served at the West Haven VA Connecticut Healthcare System. The grant, which is $880,000 over four years, began in 2010…

(December 2014)

The Veterans Health Administration (VHA) has established a Stepped Care Model of Pain Management (SCM-PM) as an evidence-based framework and single standard of pain care to promote guideline-concordant care, but to date its adoption and related outcomes have not been systematically examined.

OBJECTIVE: Our aim was to examine changes in care for Veterans receiving long-term OT for management of chronic pain over a four-year study period.

KEY RESULTS: The proportion of patients receiving high-dose opioids decreased over four years (27.7 % to 24.7 %). The use of opioid risk mitigation strategies increased significantly. Referrals to physical therapy and chiropractic care and prescriptions for topical analgesics increased significantly, while referrals to the pain medicine specialty clinic decreased.

These studies are only about the “success” of restricting opioid therapy, not about the success of patient outcomes.

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