The effect of long-term opioid use on back-specific disability and health-related quality of life in patients with chronic low back pain

Matthew J Schultz, John C Licciardone, Matthew J Schultz, John C Licciardone

Abstract

Context: Opioids are commonly utilized for the treatment of chronic pain. However, research regarding the long-term (≥12 months) outcomes of opioid therapy remains sparse.

Objectives: This study aims to evaluate the effects of long-term opioid therapy on measures of back-specific disability and health-related quality of life in patients with chronic low back pain.

Methods: In this retrospective cohort study, patients with chronic low back pain who reported consistent opioid use or abstinence for at least 12 months while enrolled in the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation Pain Research Registry were classified as long-term opioid users or nonusers, respectively. For comparison, intermediate-term and short-term opioid users and nonusers were also identified. Multiple linear regression analysis was performed to compare back-specific disability (Roland-Morris Disability Questionnaire [RMDQ]) and health-related quality of life (29-item Patient-Reported Outcomes Measurement Information System [PROMIS]) between opioid users and nonusers while controlling for pain intensity, depression, age, body mass index (BMI), and eight common comorbid conditions (herniated disc, sciatica, osteoporosis, osteoarthritis, heart disease, hypertension, diabetes, and asthma). Statistically significant findings were assessed for clinical relevance.

Results: There were 96 long-term opioid users and 204 long-term opioid nonusers. After controlling for potential confounders, long-term opioid use was a predictor of worse back-specific disability (adjusted mean difference=2.85, p<0.001), physical function (adjusted mean difference=-2.90, p=0.001), fatigue (adjusted mean difference=4.32, p=0.001), participation in social roles (adjusted mean difference=-4.10, p<0.001), and pain interference (adjusted mean difference=3.88, p<0.001) outcomes. Intermediate-term opioid use was a predictor of worse back-specific disability (adjusted mean difference=2.41, p<0.001), physical function (adjusted mean difference=-2.26, p=0.003), fatigue (adjusted mean difference=3.70, p=0.002), and sleep disturbance outcomes (adjusted mean difference=3.03, p=0.004), whereas short-term opioid use was a predictor of worse back-specific disability (adjusted mean difference=2.42, p<0.001) and physical function outcomes (adjusted mean difference=-1.90, p<0.001).

Conclusions: The findings of this study are largely consistent with existing literature regarding the outcomes of long-term opioid therapy. Taken in conjunction with the well-established risks of opioid medications, these findings draw into question the utility of long-term opioid therapy for chronic low back pain.

Keywords: chronic pain; disability; long-term opioid therapy; opioid; outcomes; quality of life.

© 2022 the author(s), published by De Gruyter, Berlin/Boston.

References

    1. Dahlhamer, J, Lucas, J, Zelaya, C, Nahin, R, Mackey, S, DeBar, L, et al.. Prevalence of chronic pain and high-impact chronic pain among adults – United States, 2016. MMWR Morb Mortal Wkly Rep 2018;67:1001–6. .
    1. Institute of Medicine. Relieving pain in America: a blueprint for transforming prevention, care, education, and research. Washington, DC: The National Academies Press; 2011. Available from: .
    1. NIH Interagency Pain Research Coordinating Committee. Federal pain research strategy; 2018. Available from: .
    1. Reuben, DB, Alvanzo, AAH, Ashikaga, T, Bogat, GA, Callahan, CM, Ruffing, V, et al.. National institutes of health pathways to prevention workshop: the role of opioids in the treatment of chronic pain. Ann Intern Med 2015;162:295–303. .
    1. Deyo, RA, Dworkin, SF, Amtmann, D, Andersson, G, Borenstein, D, Carragee, E, et al.. Report of the NIH Task Force on research standards for chronic low back pain. J Pain 2014;15:569–85. .
    1. Chaparro, LE, Furlan, AD, Deshpande, A, Mailis-Gagnon, A, Atlas, S, Turk, DC. Opioids compared to placebo or other treatments for chronic low-back pain. Cochrane Database Syst Rev 2013;1–77. .
    1. Abdel Shaheed, C, Maher, CG, Williams, KA, Day, R, McLachlan, AJ. Efficacy, tolerability, and dose-dependent effects of opioid analgesics for low back pain: a systematic review and meta-analysis. JAMA Intern Med 2016;176:958–68. .
    1. Chou, R, Deyo, R, Friedly, J, Skelly, A, Weimer, M, Fu, R, et al.. Systemic pharmacologic therapies for low back pain: a systematic review for an American College of Physicians clinical practice guideline. Ann Intern Med 2017;166:480–92. .
    1. Megale, RZ, Deveza, LA, Blyth, FM, Naganathan, V, Ferreira, PH, McLachlan, AJ, et al.. Efficacy and safety of oral and transdermal opioid analgesics for musculoskeletal pain in older adults: a systematic review of randomized, placebo-controlled trials. J Pain 2018;19:475.e1–24. .
    1. Chou, R, Turner, JA, Devine, EB, Hansen, RN, Sullivan, SD, Blazina, I, et al.. 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. Ann Intern Med 2015;162:276–86. .
    1. Qaseem, A, Wilt, TJ, McLean, RM, Forciea, MA. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2017;166:514–30. .
    1. Lee, AC, Driban, JB, Price, LL, Harvey, WF, Rodday, AM, Wang, C. Responsiveness and minimally important differences for 4 patient-reported outcomes measurement information system short forms: physical function, pain interference, depression, and anxiety in knee osteoarthritis. J Pain 2017;18:1096–110. .
    1. Kroenke, K, Talib, TL, Stump, TE, Kean, J, Haggstrom, DA, DeChant, P, et al.. Incorporating PROMIS symptom measures into primary care practice-a randomized clinical trial. J Gen Intern Med 2018;33:1245–52. .
    1. Chen, CX, Kroenke, K, Stump, TE, Kean, J, Carpenter, JS, Krebs, EE, et al.. Estimating minimally important differences for the PROMIS pain interference scales: results from 3 randomized clinical trials. Pain 2018;159:775–82. .
    1. Amtmann, D, Kim, J, Chung, H, Askew, RL, Park, R, Cook, KF. Minimally important differences for patient reported outcomes measurement information system pain interference for individuals with back pain. J Pain Res 2016;9:251–5. .
    1. Yost, KJ, Eton, DT, Garcia, SF, Cella, D. Minimally important differences were estimated for six patient-reported outcomes measurement information system-cancer scales in advanced-stage cancer patients. J Clin Epidemiol 2011;64:507–16. .
    1. Roland, M, Morris, R. A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain. Spine (Phila Pa 1976) 1983;8:141–4. .
    1. Davies, CC, Nitz, AJ. Psychometric properties of the roland-morris disability questionnaire compared to the oswestry disability index: a systematic review. Phys Ther Rev 2009;14:399–408. .
    1. Ramasamy, A, Martin, ML, Blum, SI, Liedgens, H, Argoff, C, Freynhagen, R, et al.. Assessment of patient-reported outcome instruments to assess chronic low back pain. Pain Med 2017;18:1098–110. .
    1. Cella, D, Riley, W, Stone, A, Rothrock, N, Reeve, B, Yount, S, et al.. The patient-reported outcomes measurement information system (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005–2008. J Clin Epidemiol 2010;63:1179–94. .
    1. Liu, H, Cella, D, Gershon, R, Shen, J, Morales, LS, Riley, W, et al.. Representativeness of the patient-reported outcomes measurement information system internet panel. J Clin Epidemiol 2010;63:1169–78. .
    1. Bell, TJ, Panchal, SJ, Miaskowski, C, Bolge, SC, Milanova, T, Williamson, R. The prevalence, severity, and impact of opioid-induced bowel dysfunction: results of a US and European patient survey (PROBE 1). Pain Med 2009;10:35–42. .
    1. Lembke, A, Humphreys, K, Newmark, J. Weighing the risks and benefits of chronic opioid therapy. Am Fam Physician 2016;93:982–90.
    1. Webster, LR, Choi, Y, Desai, H, Webster, L, Grant, BJ. Sleep-disordered breathing and chronic opioid therapy. Pain Med 2008;9:425–32. .
    1. Krebs, EE, Gravely, A, Nugent, S, Jensen, AC, DeRonne, B, Goldsmith, ES, et al.. Effect of opioid vs. nonopioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain: the SPACE randomized clinical trial. JAMA 2018;319:872–82. .
    1. Turner, JA, Shortreed, SM, Saunders, KW, Leresche, L, Von Korff, M. Association of levels of opioid use with pain and activity interference among patients initiating chronic opioid therapy. Pain 2016;157:849–57. .
    1. Dowell, D, Haegerich, TM, Chou, R. CDC guideline for prescribing opioids for chronic pain--United States, 2016. JAMA 2016;315:1624–45. .
    1. Elsesser, K, Cegla, T. Long-term treatment in chronic noncancer pain: results of an observational study comparing opioid and nonopioid therapy. Scand J Pain 2017;17:87–98. .
    1. Thornton, JD, Goyat, R, Dwibedi, N, Kelley, GA. Health-related quality of life in patients receiving long-term opioid therapy: a systematic review with meta-analysis. Qual Life Res 2017;26:1955–67. .
    1. Morasco, BJ, Yarborough, BJ, Smith, NX, Dobscha, SK, Deyo, RA, Perrin, NA, et al.. Higher prescription opioid dose is associated with worse patient-reported pain outcomes and more health care utilization. J Pain 2017;18:437–45. .
    1. Ferrari, R, Zanolin, ME, Duse, G, Visentin, M. Effectiveness of opioid analgesics in chronic noncancer pain. Pain Pract 2015;15:272–8. .
    1. Adams, MH, Dobscha, SK, Smith, NX, Yarborough, BJ, Deyo, RA, Morasco, BJ. Prevalence and correlates of low pain interference among patients with high pain intensity who are prescribed long-term opioid therapy. J Pain 2018;19:1074–81. .
    1. Boudreau, D, Von Korff, M, Rutter, CM, Saunders, K, Ray, GT, Sullivan, MD, et al.. Trends in long-term opioid therapy for chronic non-cancer pain. Pharmacoepidemiol Drug Saf 2009;18:1166–75. .
    1. Frank, JW, Lovejoy, TI, Becker, WC, Morasco, BJ, Koenig, CJ, Hoffecker, L, et al.. Patient outcomes in dose reduction or discontinuation of long-term opioid therapy: a systematic review. Ann Intern Med 2017;167:181–91. .
    1. Lozier, CC, Nugent, SM, Smith, NX, Yarborough, BJ, Dobscha, SK, Deyo, RA, et al.. Correlates of use and perceived effectiveness of non-pharmacologic strategies for chronic pain among patients prescribed long-term opioid therapy. J Gen Intern Med 2018;33:46–53. .
    1. Shah, D, Zhao, X, Wei, W, Gandhi, K, Dwibedi, N, Webster, L, et al.. A longitudinal study of the association of opioid use with change in pain interference and functional limitations in a nationally representative cohort of adults with osteoarthritis in the United States. Adv Ther 2020;37:819–32. .
    1. Strick, V. Management of severe chronic pain with tapentadol prolonged release – long-term data from pain specialists. Curr Med Res Opin 2014;30:2085–92. .
    1. Zgierska, AE, Burzinski, CA, Cox, J, Kloke, J, Singles, J, Mirgain, S, et al.. Mindfulness meditation-based intervention is feasible, acceptable, and safe for chronic low back pain requiring long-term daily opioid therapy. J Alternative Compl Med 2016;22:610–20. .
    1. Shen, Y, Bhagwandass, H, Branchcomb, T, Galvez, SA, Grande, I, Lessing, J, et al.. Chronic opioid therapy: a scoping literature review on evolving clinical and scientific definitions. J Pain 2021;22:246–62. .

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere