Long-Term Opioid Therapy Reconsidered

Group Health Research Institute, Seattle, Washington 98101, USA.
Annals of internal medicine (Impact Factor: 17.81). 09/2011; 155(5):325-8. DOI: 10.1059/0003-4819-155-5-201109060-00011
Source: PubMed

ABSTRACT In the past 20 years, primary care physicians have greatly increased prescribing of long-term opioid therapy. However, the rise in opioid prescribing has outpaced the evidence regarding this practice. Increased opioid availability has been accompanied by an epidemic of opioid abuse and overdose. The rate of opioid addiction among patients receiving long-term opioid therapy remains unclear, but research suggests that opioid misuse is not rare. Recent studies report increased risks for serious adverse events, including fractures, cardiovascular events, and bowel obstruction, although further research on medical risks is needed. New data indicate that opioid-related risks may increase with dose. From a societal perspective, higher-dose regimens account for the majority of opioids dispensed, so cautious dosing may reduce both diversion potential and patient risks for adverse effects. Limiting long-term opioid therapy to patients for whom it provides decisive benefits could also reduce risks. Given the warning signs and knowledge gaps, greater caution and selectivity are needed in prescribing long-term opioid therapy. Until stronger evidence becomes available, clinicians should err on the side of caution when considering this treatment.

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Available from: Richard Deyo, Sep 27, 2015
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    • "Side effects, absence of any improvement in physical function, misuse, abuse, and addiction are relatively common during chronic opioid administration. The American literature reports overall rates of opioid misuse and abuse ranging from 4% to 26% [4] [5]. Such different rates may be due to a lack of a universally accepted definition of terms that describe the various types of incorrect behavior consequent to chronic opioid prescription. "
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    ABSTRACT: Objective. Opioid therapy in patients with chronic noncancer pain must be preceded by evaluation of the risk of opioid misuse. The aim of this study was to evaluate the predictive validity of the Italian translation of the Pain Medication Questionnaire (PMQ) and of the Diagnosis Intractability Risk and Efficacy Score (DIRE) in chronic pain patients. Design. 75 chronic noncancer pain patients treated with opioids were enrolled and followed longitudinally. Risk of opioid misuse was evaluated through PMQ, DIRE, and the physician's clinical evaluation. Pain experience and psychological characteristics were assessed through specific self-report instruments. At follow-ups, pain intensity, aberrant drug behaviors, and presence of the prescribed opioid and of illegal substances in urine were also checked. Results. PMQ demonstrated good internal consistency (Cronbach's α = 0.77) and test-retest reliability (r = 0.86). Significant correlations were found between higher PMQ scores and the number of aberrant drug behaviors detected at 2-, 4-, and 6-month follow-ups (P < 0.01). Also the DIRE demonstrated good predictive validity. Conclusions. The results obtained with specific tools are more reliable than the clinician's evaluation alone in predicting the risk of opioid misuse; regular monitoring and psychological intervention will contribute to improving compliance and outcome of long-term opioid use.
    Pain Research and Treatment 08/2014; 2014:584986. DOI:10.1155/2014/584986
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    • "Pain medications are the second most prescribed class of drugs (after cardiac-renal drugs), accounting for 12% of all medication prescribed during ambulatory office visits in the United States [12]. Yet analgesics fail to provide adequate relief in many patients [13] [14]. At the same time, clinicians are being pressured to respond to pain as the " fifth vital sign " [15]. "
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