The jury is still out on this one…
Recently, the National Institutes of Health (NIH) commissioned the Agency for Healthcare Research and Quality (AHRQ) to conduct a systematic review* of the current evidence on long-term opioid therapy for chronic pain. The results were used to inform the NIH workshop, Pathways to Prevention: The Role of Opioids in the Treatment of Chronic Pain. A key finding of the AHRQ report was that the confidence level in the efficacy of long-term therapy was ranked “no higher than low” due to methodological shortcomings and imprecision.
Other findings of the report were that:
- Long-term opioid therapy was associated with increased risk of abuse, overdose, fracture, myocardial infarction, and markers of sexual dysfunction, with several studies showing a dose-dependent association.
- Methodological shortcomings—such as varied definitions and measures—made it difficult to draw conclusions, as shown by:
- In 10 uncontrolled studies, rates of opioid abuse were 0.6-8% and rates of dependence were 3-26% in primary care settings, but definitions and measures varied.
- Rates of aberrant drug-related behaviors ranged from 5-37%.
- To date, no study has evaluated effects of long-term opioid therapy versus no opioid therapy.
*Chou R, Deyo R, Devine B, Hansen R, Sullivan S, Jarvik JG, Blazina I, Dana T, Bougatsos C, Turner J. The Effectiveness and Risks of Long-Term Opioid Treatment of Chronic Pain. Evidence Report/Technology Assessment No. 218. (Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No. 290-2012-00014-I.) AHRQ Publication No. 14-E005-EF. Rockville, MD: Agency for Healthcare Research and Quality; September 2014.