BACKGROUND: The use of opioids for chronic noncancer pain (CNCP) remains controversial. Despite a number of randomized controlled trials showing efficacy and safety in the short term, long-term data are limited. OBJECTIVE: To survey a selected cohort of patients with intractable CNCP with regard to long-term efficacy and safety of opioids. METHODS: The present study reports long-term results from a survey of 84 patients with CNCP. The majority of patients had neuropathic pain, were treated with opioids and were followed every three months for a median of 8.4 years. Outcomes examined were pain severity, adverse effects, pain relief, satisfaction, mood, problematic opioid use, tolerance, physical dependency, functional status, health-related quality of life, immune status, sexual function, morbidity and mortality. Measures included a numerical rating scale, the Hospital Anxiety and Depression Scale, Brief Pain Inventory interference scale, Pain Disability Index and Short-Form Health Survey 12, version 2. RESULTS AND CONCLUSIONS: Both long- and short-acting opioids were reported to be effective, with few significant long-term adverse effects in many subjects in the present selected cohort. The majority of patients reported at least 50% or greater pain relief and a moderate improvement in disability. Functional status and health-related quality of life scores were not severely affected. Problematic opioid use, tolerance and serious adverse effects, including constipation, were not major issues. The authors emphasize that the results obtained in the present selected group may not be generalizable to all CNCP patients in whom opioids are being initiated.
BACKGROUND: The use of opioids for chronic noncancer pain (CNCP) remains controversial. Despite a number of randomized controlled trials showing efficacy and safety in the short term, long-term data are limited. OBJECTIVE: To survey a selected cohort of patients with intractable CNCP with regard to long-term efficacy and safety of opioids. METHODS: The present study reports long-term results from a survey of 84 patients with CNCP. The majority of patients had neuropathic pain, were treated with opioids and were followed every three months for a median of 8.4 years. Outcomes examined were pain severity, adverse effects, pain relief, satisfaction, mood, problematic opioid use, tolerance, physical dependency, functional status, health-related quality of life, immune status, sexual function, morbidity and mortality. Measures included a numerical rating scale, the Hospital Anxiety and Depression Scale, Brief Pain Inventory interference scale, Pain Disability Index and Short-Form Health Survey 12, version 2. RESULTS AND CONCLUSIONS: Both long- and short-acting opioids were reported to be effective, with few significant long-term adverse effects in many subjects in the present selected cohort. The majority of patients reported at least 50% or greater pain relief and a moderate improvement in disability. Functional status and health-related quality of life scores were not severely affected. Problematic opioid use, tolerance and serious adverse effects, including constipation, were not major issues. The authors emphasize that the results obtained in the present selected group may not be generalizable to all CNCP patients in whom opioids are being initiated.
Authors: Robert H Dworkin; Dennis C Turk; John T Farrar; Jennifer A Haythornthwaite; Mark P Jensen; Nathaniel P Katz; Robert D Kerns; Gerold Stucki; Robert R Allen; Nicholas Bellamy; Daniel B Carr; Julie Chandler; Penney Cowan; Raymond Dionne; Bradley S Galer; Sharon Hertz; Alejandro R Jadad; Lynn D Kramer; Donald C Manning; Susan Martin; Cynthia G McCormick; Michael P McDermott; Patrick McGrath; Steve Quessy; Bob A Rappaport; Wendye Robbins; James P Robinson; Margaret Rothman; Mike A Royal; Lee Simon; Joseph W Stauffer; Wendy Stein; Jane Tollett; Joachim Wernicke; James Witter Journal: Pain Date: 2005-01 Impact factor: 6.961
Authors: Ian Gilron; Joan M Bailey; Dongsheng Tu; Ronald R Holden; Donald F Weaver; Robyn L Houlden Journal: N Engl J Med Date: 2005-03-31 Impact factor: 91.245
Authors: Y Harati; C Gooch; M Swenson; S Edelman; D Greene; P Raskin; P Donofrio; D Cornblath; R Sachdeo; C O Siu; M Kamin Journal: Neurology Date: 1998-06 Impact factor: 9.910