Open AccessEffectiveness of Long-Term Opioid Therapy for Chronic Non-Cancer Pain
Author(s) -
Laxmaiah Manchikanti,
Ricardo Vallejo,
Kavita N. Manchikanti,
Ramsin Benyamin,
Sukdeb Datta,
Paul J. Christo
Publication year - 2011
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2011/14/e133
Subject(s) - medicine , chronic pain , opioid , intensive care medicine , adverse effect , observational study , cancer pain , oxycodone , randomized controlled trial , psychosocial , physical therapy , cancer , psychiatry , receptor
Background: Opioids have been utilized for thousands of years to treat pain and their usecontinues to escalate. It is estimated that 90% of the patients who present to pain centers andreceive treatment in such facilities are on opioids. However, in contrast to increasing opioiduse and the lack of evidence supporting long-term effectiveness in chronic non-cancer pain,is the escalating misuse of prescription opioids, including abuse and diversion. There is alsouncertainty about the incidence and clinical salience of multiple, poorly characterized adversedrug events, including endocrine dysfunction, immunosuppression, infectious disease, opioidinduced hyperalgesia, overdoses, deaths, and psychosocial and economic implications.Study Design: A comprehensive review of the literature.Objective: The objective of this comprehensive review is to evaluate the clinical effectivenessand safety of chronic opioid therapy in chronic non-cancer pain.Methods: A comprehensive review of the literature relating to chronic opioid therapyin chronic non-cancer pain. The literature was collected from various electronic and othersources. The literature that was evaluated included randomized trials, observational studies,case reports, systematic reviews, and guidelines.Outcome Measures: Pain relief was the primary outcome measure. The secondary outcomemeasures were functional improvement and adverse effects. Short-term effectiveness wasconsidered to be less than 6 months; long-term effectiveness was considered to be at leastone year.Results: Given the complexity and widespread nature of opioid therapy, there is a paucityof qualitative and/or quantitative literature. The available evidence is weak for pain reliefcombined with improvement in functional status. Only one drug, tramadol, is effective forpain relief and improvement of functional status.Limitations: This is a narrative review without application of methodologic qualityassessment criteria. Even so, a paucity of literature exists concerning both controlled andobservational literature for multiple drugs and multiple conditions of chronic non-cancerpain.Conclusions: This comprehensive review illustrates the lack of literature on long-termopioid therapy; thus, opioid therapy should be provided with great restraint and caution,based on the weak evidence available.Key words: Chronic non-cancer pain, opioids, opioid effectiveness, adverse effects,morphine, hydrocodone, hydromorphone, fentanyl, tramadol, methadone, oxycodone