Stopping long-term opioid treatment does not make chronic, non-cancer-related pain worse and, in some cases, makes it better, according to US researchers.
The Washington State University researchers said their study findings questioned the value of long-term opioid therapy for chronic, non-cancer pain.
“Our results indicate that long term opioid therapy does not effectively manage patient pain intensity”
They also said it marked a crucial first step towards understanding how ending long-term opioids affected patients with different types of chronic pain and may help clinicians identify effective alternatives.
Researchers, from the Veteran Affairs Portland Health Care System and the Oregon Health and Science University, analysed survey responses from 551 patients who had been on long-term opioid therapy for chronic, non-cancer-related pain for at least a year before discontinuing the medication.
Of those involved in the study, 87% of the patients were diagnosed with chronic musculoskeletal pain, 6% with neuropathic pain and 11% with headache pain, including migraines.
Survey subjects rated their pain over two years, scoring it on a scale of 0-10 where 0 equals no pain and 10 equals the worst possible pain.
The researchers used biostatistical analysis and computer modeling to characterise changes in pain intensity 12 months before the patients ended opioid therapy and the 12 months after.
“We are now going to try and understand what different mechanisms may be at work”
While patients differed widely in the intensity of pain they experienced before and after stopping opioids, as a whole their pain did not get worse and remained similar or slightly improved.
Study author Sterling McPherson, associate professor and director for biostatistics and clinical trial design, said: “On average, pain did not become worse among patients in our study a year after discontinuing long-term opioid therapy.
“If anything, their pain improved slightly, particularly among patients with mild to moderate pain just after discontinuation,” said Dr McPherson.
He added: “Our results indicate that long term opioid therapy does not effectively manage patient pain intensity any more effectively than not receiving long-term opioid therapy.
“Clinicians might consider these findings when discussing the risks and benefits of long-term opioid therapy as compared to other, non-opioid treatments for chronic pain,” he said.
He noted: “There are a variety of treatments available for the management of chronic pain other than opioids and our hope is that this research will help promote conversations about these alternatives.”
The researchers now plan to collect additional data and conduct interviews with patients over the next year to try and determine why some patients experience greater reductions in pain than others after discontinuing long-term opioid therapy
“As part of our study, we grouped our patients into one of four categories based on the amount of pain they reported before and after discontinuing long-term opioid therapy,” said Dr McPherson.
“We are now going to try and understand what different mechanisms may be at work for reducing or increasing chronic pain for each of these sub-groups,” he said.
“Our hope is this will lead to being able to target specific sub-populations with different types of treatment for their chronic pain,” he added.
The increasing use of powerful opioid painkillers in the US since the early 1990s has been recently seen as a major problem due to overdose deaths.
According to the US Centers for Disease Control and Prevention, over 63,600 Americans died from drug overdose deaths in 2016, of which 42,249, involved opioids.
The new study, published in the journal Pain, is one of the first to investigate what, if any, are the potential adverse effects of discontinuing long-term opioids for chronic, non-cancer-related pain.