Abstract
Purpose
Over 25 million Americans reported having daily pain and between 5 and 8 million Americans used opioids to treat chronic pain in 2012. This is the first systematic review with meta-analysis to determine the effects of long-term opioid use on the Physical Component Summary (PCS) score and Mental Component Summary (MCS) scores of a Health-Related Quality of Life instrument in adults without opioid use disorder.
Methods
The a priori eligibility criteria for the PubMed (MEDLINE), Scopus, and PsyINFO searches were (1) randomized controlled trial, (2) at least one opioid intervention group, (3) minimum of 4-week duration of opioid use, (4) comparative control group, and (5) adults ≥18 years that do not have dominant disease. The unit of analysis was the standardized mean difference effect size (Hedges’s g). All results were pooled using random-effects models.
Results
Of the 340 non-duplicate citations screened, 19 articles comprising 26 treatment comparisons and 6168 individuals (treatment n = 3160; comparators n = 3008 with duplicates removed) met the inclusion criteria for the systematic review. Thirteen treatment comparisons were available for the meta-analysis. Across all PCS analyses, small, statistically significant improvements were observed (opioid versus opioid only: g = 0.27, 95% CI 0.05–0.50, opioid versus placebo only: g = 0.18, 95% CI 0.08–0.28, and all studies combined: g = 0.22, 95% CI 0.11–0.32). There were small but not statistically significant changes on the MCS scores. Overall, high heterogeneity was present.
Conclusions
PCS scores improve with no change in MCS scores. However, long-term opioid trials are rare and only two trials included lasted longer than 1 year.
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Funding
GAK was supported by the National Institutes of Health, National Institute of General Medical Sciences (Grant Number U54GM104942). JDT was supported by the National Institutes of Health, National Institute of General Medical Sciences (Grant Number 5T32GM081741-08). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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JDT, RG, ND, and GAK declare that they have no conflicts of interests.
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Thornton, J.D., Goyat, R., Dwibedi, N. et al. Health-related quality of life in patients receiving long-term opioid therapy: a systematic review with meta-analysis. Qual Life Res 26, 1955–1967 (2017). https://doi.org/10.1007/s11136-017-1538-0
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DOI: https://doi.org/10.1007/s11136-017-1538-0