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Opioid Therapy for Long-Term Pain Control in Non-terminal Patients

  • Pain Medicine (GJ Meredith, Section Editor)
  • Published:
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Abstract

In the US, the 1980s and 1990s were a period of renewed interest in the use of opioids, particularly for the palliation of patients with malignancy or terminal illness, but also for the treatment of chronic, non-terminal pain. However, as the number of prescription opioid overdose deaths rose, the medical profession was compelled to take a more systematic look at the risks and benefits of long-term opioid use. Three consecutive systematic reviews—by the American Pain Society in 2009, the Agency for Healthcare Research and Quality in 2014, and the Centers for Disease Control and Prevention in 2016—brought to light the mounting evidence for adverse outcomes associated with long-term opioid use, as well as the paucity of evidence for long-term benefit.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. •• Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States, 2016. MMWR Recomm Rep. 2016;65(1):1–49. Published in 2016, the CDC report updated the systematic review performed in the AHRQ study listed in citation 8. They found insufficient evidence to answer the question of the efficacy of long-term opioid therapy versus non-opioid alternatives.

  2. Tsang A, Von Korff M, Lee S, Alonso J, Karam E, Angermeyer MC, Borges GL, Bromet EJ, Demytteneare K, De Girolamo G, De Graaf R, Gureje O, Lepine JP, Haro JM, Levinson D, Oakley Browne MA, Posada-Villa J, Seedat S, Watanabe M. Common chronic pain conditions in developed and developing countries: gender and age differences and comorbidity with depression-anxiety disorders. J Pain. 2008;9(10):883–91.

    Article  PubMed  Google Scholar 

  3. Nahin RL. Estimates of pain prevalence and severity in adults: United States, 2012. J Pain. 2012;16(8):769–80.

    Article  Google Scholar 

  4. Daubresse M, Chang HY, Yu Y, Viswanathan S, Shah ND, Stafford RS, Kruszewski SP, Alexander GC. Ambulatory diagnosis and treatment of nonmalignant pain in the United States, 2000–2010. Med Care. 2013;51(10):870–8.

    Article  PubMed  Google Scholar 

  5. National Institute on Drug Abuse. Prescription Opioid and Heroin Abuse. 2014.

  6. National Institute on Drug Abuse. Overdose death rates. 2015.

  7. •• American Pain Society. Guideline for the use of chronic opioid therapy in chronic noncancer pain: evidence review. American Academy of Pain Medicine Opioids Guidelines Panel; Chicago: American Pain Society; 2009. The APS published the first systematic review of opioid therapy for chronic non-terminal pain using explicit criteria to evaluate the strength of evidence for recommendations about the potential benefits and harms.

  8. •• Chou R, Deyo R, Devine B, Hansen R, Sullivan S, Jarvik JG, Blazina I, Dana T, Bougatsos C, Turner J. The effectiveness and risks of long-term opioid treatment of chronic pain. Evidence report/technology assessment No. 218. (Prepared by the Pacific Northwest evidence-based practice center under contract No. 290-2012-00014-I.) AHRQ publication No. 14-E005-EF. Rockville, MD: Agency for Healthcare Research and Quality; 2014. http://www.effectivehealthcare.ahrq.gov/reports/final.cfm. The AHRQ commissioned a second systematic review that built on the literature base found in the APS study above. The literature search used in the AHRQ study was replicated and updated in the CDC systematic review listed in citation 1.

  9. Olsen Y. The CDC guideline on opioid prescribing: rising to the challenge. JAMA. 2016;315(15):1577–9.

    Article  PubMed  Google Scholar 

  10. Quality improvement guidelines for the treatment of acute pain and cancer pain. American Pain Society Quality of Care Committee. JAMA. 1995;274(23):1874–80.

  11. Phillips DM. JCAHO pain management standards are unveiled. Joint Commission on Accreditation of Healthcare Organizations. JAMA. 2000;284(4):428–9.

    Article  CAS  PubMed  Google Scholar 

  12. The Management of Opioid Therapy for Chronic Pain Working Group. VA/DoD Clinical practical guidelines for the management of opioid therapy for chronic pain. 2003.

  13. Van Zee A. The promotion and marketing of oxycontin: commercial triumph, public health tragedy. Am J Public Health. 2009;99(2):221–7.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Ballantyne JC, Mao J. Opioid therapy for chronic pain. N Engl J Med. 2003;349(20):1943–53.

    Article  CAS  PubMed  Google Scholar 

  15. Portenoy RK, Foley KM. Chronic use of opioid analgesics in non-malignant pain: report of 38 cases. Pain. 1986;25(2):171–86.

    Article  CAS  PubMed  Google Scholar 

  16. Simpson RK Jr, Edmondson EA, Constant CF, Collier C. Transdermal fentanyl as treatment for chronic low back pain. J Pain Symptom Manage. 1997;14(4):218–24.

    Article  PubMed  Google Scholar 

  17. Ytterberg SR, Mahowald ML, Woods SR. Codeine and oxycodone use in patients with chronic rheumatic disease pain. Arthritis Rheum. 1998;41(9):1603–12.

    Article  CAS  PubMed  Google Scholar 

  18. Rowbotham MC, Twilling L, Davies PS, Reisner L, Taylor K, Mohr D. Oral opioid therapy for chronic peripheral and central neuropathic pain. N Engl J Med. 2003;348(13):1223–32.

    Article  CAS  PubMed  Google Scholar 

  19. Jadad AR, Carroll D, Glynn CJ, Moore RA, McQuay HJ. Morphine responsiveness of chronic pain: double-blind randomised crossover study with patient-controlled analgesia. Lancet. 1992;339(8806):1367–71.

    Article  CAS  PubMed  Google Scholar 

  20. Raja SN, Haythornthwaite JA, Pappagallo M, Clark MR, Travison TG, Sabeen S, Royall RM, Max MB. Opioids versus antidepressants in postherpetic neuralgia: a randomized, placebo-controlled trial. Neurology. 2002;59(7):1015–21.

    Article  CAS  PubMed  Google Scholar 

  21. Kjaersgaard-Andersen P, Nafei A, Skov O, Madsen F, Andersen HM, Kroner K, Hvass I, Gjoderum O, Pedersen L, Branebjerg PE. Codeine plus paracetamol versus paracetamol in longer-term treatment of chronic pain due to osteoarthritis of the hip. A randomised, double-blind, multi-centre study. Pain. 1990;43(3):309–18.

    Article  CAS  PubMed  Google Scholar 

  22. Peloso PM, Bellamy N, Bensen W, Thomson GT, Harsanyi Z, Babul N, Darke AC. Double blind randomized placebo control trial of controlled release codeine in the treatment of osteoarthritis of the hip or knee. J Rheumatol. 2000;27(3):764–71.

    CAS  PubMed  Google Scholar 

  23. Roth SH, Fleischmann RM, Burch FX, Dietz F, Bockow B, Rapoport RJ, Rutstein J, Lacouture PG. Around-the-clock, controlled-release oxycodone therapy for osteoarthritis-related pain: placebo-controlled trial and long-term evaluation. Arch Intern Med. 2000;160(6):853–60.

    Article  CAS  PubMed  Google Scholar 

  24. Jamison RN, Raymond SA, Slawsby EA, Nedeljkovic SS, Katz NP. Opioid therapy for chronic noncancer back pain. A randomized prospective study. Spine (Phila Pa 1976). 1998;23(23):2591–600.

    Article  CAS  Google Scholar 

  25. Arkinstall W, Sandler A, Goughnour B, Babul N, Harsanyi Z, Darke AC. Efficacy of controlled-release codeine in chronic non-malignant pain: a randomized, placebo-controlled clinical trial. Pain. 1995;62(2):169–78.

    Article  CAS  PubMed  Google Scholar 

  26. Moulin DE, Iezzi A, Amireh R, Sharpe WK, Boyd D, Merskey H. Randomised trial of oral morphine for chronic non-cancer pain. Lancet. 1996;347(8995):143–7.

    Article  CAS  PubMed  Google Scholar 

  27. Maier C, Hildebrandt J, Klinger R, Henrich-Eberl C, Lindena G. Morphine responsiveness, efficacy and tolerability in patients with chronic non-tumor associated pain—results of a double-blind placebo-controlled trial (MONTAS). Pain. 2002;97(3):223–33.

    Article  CAS  PubMed  Google Scholar 

  28. Bombardier C. Outcome assessments in the evaluation of treatment of spinal disorders. Introduction. Spine (Phila Pa 1976). 2000;25(24):3097–9.

    Article  CAS  Google Scholar 

  29. Fairbank JC, Pynsent PB. The oswestry disability index. Spine (Phila Pa 1976). 2000;25(22):2940–52 discussion 52.

    Article  CAS  Google Scholar 

  30. Martell BA, O’Connor PG, Kerns RD, Becker WC, Morales KH, Kosten TR, Fiellin DA. Systematic review: opioid treatment for chronic back pain: prevalence, efficacy, and association with addiction. Ann Intern Med. 2007;146(2):116–27.

    Article  PubMed  Google Scholar 

  31. Devulder J, Richarz U, Nataraja SH. Impact of long-term use of opioids on quality of life in patients with chronic, non-malignant pain. Curr Med Res Opin. 2005;21(10):1555–68.

    Article  CAS  PubMed  Google Scholar 

  32. Cepeda MS, Camargo F, Zea C, Valencia L. Tramadol for osteoarthritis. Cochrane Database Syst Rev. 2006. doi:https://doi.org/10.1002/14651858.CD005522.pub2.

  33. Clark AJ, Ahmedzai SH, Allan LG, Camacho F, Horbay GL, Richarz U, Simpson K. Efficacy and safety of transdermal fentanyl and sustained-release oral morphine in patients with cancer and chronic non-cancer pain. Curr Med Res Opin. 2004;20(9):1419–28.

    Article  CAS  PubMed  Google Scholar 

  34. Deshpande A, Furlan A, Mailis-Gagnon A, Atlas S, Turk D. Opioids for chronic low-back pain. Cochrane Database Syst Rev. 2007. doi:https://doi.org/10.1002/14651858.CD004959.pub3.

  35. Furlan AD, Sandoval JA, Mailis-Gagnon A, Tunks E. Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects. CMAJ. 2006;174(11):1589–94.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Hollingshead J, Duhmke RM, Cornblath DR. Tramadol for neuropathic pain. Cochrane Database Syst Rev. 2006. doi:https://doi.org/10.1002/14651858.CD003726.pub3.

  37. Kalso E, Edwards JE, Moore RA, McQuay HJ. Opioids in chronic non-cancer pain: systematic review of efficacy and safety. Pain. 2004;112(3):372–80.

    Article  CAS  PubMed  Google Scholar 

  38. Moore RA, McQuay HJ. Prevalence of opioid adverse events in chronic non-malignant pain: systematic review of randomised trials of oral opioids. Arthritis Res Ther. 2005;7(5):R1046–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Noble M, Tregear SJ, Treadwell JR, Schoelles K. Long-term opioid therapy for chronic noncancer pain: a systematic review and meta-analysis of efficacy and safety. J Pain Symptom Manage. 2008;35(2):214–28.

    Article  PubMed  Google Scholar 

  40. Sandoval JA, Furlan AD, Mailis-Gagnon A. Oral methadone for chronic noncancer pain: a systematic literature review of reasons for administration, prescription patterns, effectiveness, and side effects. Clin J Pain. 2005;21(6):503–12.

    Article  PubMed  Google Scholar 

  41. Eisenberg E, McNicol ED, Carr DB. Efficacy and safety of opioid agonists in the treatment of neuropathic pain of nonmalignant origin: systematic review and meta-analysis of randomized controlled trials. JAMA. 2005;293(24):3043–52.

    Article  CAS  PubMed  Google Scholar 

  42. Allan L, Richarz U, Simpson K, Slappendel R. Transdermal fentanyl versus sustained release oral morphine in strong-opioid naive patients with chronic low back pain. Spine (Phila Pa 1976). 2005;30(22):2484–90.

    Article  Google Scholar 

  43. Salzman RT, Brobyn RD. Long-term comparison of suprofen and propoxyphene in patients with osteoarthritis. Pharmacology. 1983;27(Suppl 1):55–64.

    Article  PubMed  Google Scholar 

  44. Centers for Disease Control and Prevention. Clinical evidence review for the CDC guideline for prescribing opioids for chronic pain—United States, 2016.

  45. Simpson DM, Messina J, Xie F, Hale M. Fentanyl buccal tablet for the relief of breakthrough pain in opioid-tolerant adult patients with chronic neuropathic pain: a multicenter, randomized, double-blind, placebo-controlled study. Clin Ther. 2007;29(4):588–601.

    Article  CAS  PubMed  Google Scholar 

  46. Hartung DM, Middleton L, Haxby DG, Koder M, Ketchum KL, Chou R. Rates of adverse events of long-acting opioids in a state Medicaid program. Ann Pharmacother. 2007;41(6):921–8.

    Article  CAS  PubMed  Google Scholar 

  47. Gomes T, Mamdani MM, Dhalla IA, Paterson JM, Juurlink DN. Opioid dose and drug-related mortality in patients with nonmalignant pain. Arch Intern Med. 2011;171(7):686–91.

    Article  CAS  PubMed  Google Scholar 

  48. • Li L, Setoguchi S, Cabral H, Jick S. Opioid use for noncancer pain and risk of fracture in adults: a nested case-control study using the general practice research database. Am J Epidemiol. 2013;178(4):559–69. This study was included in the AHRQ and CDC studies and supported the association between the current use of 1 opioid prescription and risk of fracture, although the risk decreased with increasing use.

  49. Boscarino JA, Rukstalis M, Hoffman SN, Han JJ, Erlich PM, Gerhard GS, Stewart WF. Risk factors for drug dependence among out-patients on opioid therapy in a large US health-care system. Addiction. 2010;105(10):1776–82.

    Article  PubMed  Google Scholar 

  50. • Deyo RA, Smith DH, Johnson ES, Tillotson CJ, Donovan M, Yang X, Petrik A, Morasco BJ, Dobscha SK. Prescription opioids for back pain and use of medications for erectile dysfunction. Spine (Phila Pa 1976). 2013;38(11):909–15. This cross-sectional analysis was included in the AHRQ and CDC systematic reviews. They found that long-term use of opioids was associated with use of medications for erectile dysfunction or testosterone replacement.

  51. Saunders KW, Dunn KM, Merrill JO, Sullivan M, Weisner C, Braden JB, Psaty BM, Von Korff M. Relationship of opioid use and dosage levels to fractures in older chronic pain patients. J Gen Intern Med. 2010;25(4):310–5.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Gomes T, Redelmeier DA, Juurlink DN, Dhalla IA, Camacho X, Mamdani MM. Opioid dose and risk of road trauma in Canada: a population-based study. JAMA Intern Med. 2013;173(3):196–201.

    Article  PubMed  Google Scholar 

  53. Daniell HW. Hypogonadism in men consuming sustained-action oral opioids. J Pain. 2002;3(5):377–84.

    Article  PubMed  Google Scholar 

  54. Daniell HW. Opioid endocrinopathy in women consuming prescribed sustained-action opioids for control of nonmalignant pain. J Pain. 2008;9(1):28–36.

    Article  CAS  PubMed  Google Scholar 

  55. Edlund MJ, Martin BC, Russo JE, DeVries A, Braden JB, Sullivan MD. The role of opioid prescription in incident opioid abuse and dependence among individuals with chronic noncancer pain: the role of opioid prescription. Clin J Pain. 2014;30(7):557–64.

    PubMed  PubMed Central  Google Scholar 

  56. Banta-Green CJ, Merrill JO, Doyle SR, Boudreau DM, Calsyn DA. Opioid use behaviors, mental health and pain–development of a typology of chronic pain patients. Drug Alcohol Depend. 2009;104(1–2):34–42.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Compton PA, Wu SM, Schieffer B, Pham Q, Naliboff BD. Introduction of a self-report version of the prescription drug use questionnaire and relationship to medication agreement noncompliance. J Pain Symptom Manage. 2008;36(4):383–95.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Cowan DT, Wilson-Barnett J, Griffiths P, Allan LG. A survey of chronic noncancer pain patients prescribed opioid analgesics. Pain Med. 2003;4(4):340–51.

    Article  PubMed  Google Scholar 

  59. Fleming MF, Balousek SL, Klessig CL, Mundt MP, Brown DD. Substance use disorders in a primary care sample receiving daily opioid therapy. J Pain. 2007;8(7):573–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Hojsted J, Nielsen PR, Guldstrand SK, Frich L, Sjogren P. Classification and identification of opioid addiction in chronic pain patients. Eur J Pain. 2010;14(10):1014–20.

    Article  PubMed  Google Scholar 

  61. Portenoy RK, Farrar JT, Backonja MM, Cleeland CS, Yang K, Friedman M, Colucci SV, Richards P. Long-term use of controlled-release oxycodone for noncancer pain: results of a 3-year registry study. Clin J Pain. 2007;23(4):287–99.

    Article  PubMed  Google Scholar 

  62. Saffier K, Colombo C, Brown D, Mundt MP, Fleming MF. Addiction Severity Index in a chronic pain sample receiving opioid therapy. J Subst Abuse Treat. 2007;33(3):303–11.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Schneider JP, Kirsh KL. Defining clinical issues around tolerance, hyperalgesia, and addiction: a quantitative and qualitative outcome study of long-term opioid dosing in a chronic pain practice. J Opioid Manag. 2010;6(6):385–95.

    Article  PubMed  Google Scholar 

  64. Wasan AD, Butler SF, Budman SH, Fernandez K, Weiss RD, Greenfield SF, Jamison RN. Does report of craving opioid medication predict aberrant drug behavior among chronic pain patients? Clin J Pain. 2009;25(3):193–8.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Dunn KM, Saunders KW, Rutter CM, Banta-Green CJ, Merrill JO, Sullivan MD, Weisner CM, Silverberg MJ, Campbell CI, Psaty BM, Von Korff M. Opioid prescriptions for chronic pain and overdose: a cohort study. Ann Intern Med. 2010;152(2):85–92.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Carman WJ, Su S, Cook SF, Wurzelmann JI, McAfee A. Coronary heart disease outcomes among chronic opioid and cyclooxygenase-2 users compared with a general population cohort. Pharmacoepidemiol Drug Saf. 2011;20(7):754–62.

    Article  CAS  PubMed  Google Scholar 

  67. • Li L, Setoguchi S, Cabral H, Jick S. Opioid use for noncancer pain and risk of myocardial infarction amongst adults. J Intern Med. 2013;273(5):511–26. This study was included in the AHRQ and CDC systematic reviews. This study was included in the AHRQ and CDC systematic reviews. Using a case-control study design, they found an association between current opioid use or cumulative use of 11 or more prescriptions and an increased risk of having an MI.

  68. Daniell HW. DHEAS deficiency during consumption of sustained-action prescribed opioids: evidence for opioid-induced inhibition of adrenal androgen production. J Pain. 2006;7(12):901–7.

    Article  CAS  PubMed  Google Scholar 

  69. Salzman RT, Roberts MS, Wild J, Fabian C, Reder RF, Goldenheim PD. Can a controlled-release oral dose form of oxycodone be used as readily as an immediate-release form for the purpose of titrating to stable pain control? J Pain Symptom Manage. 1999;18(4):271–9.

    Article  CAS  PubMed  Google Scholar 

  70. Mitra F, Chowdhury S, Shelley M, Williams G. A feasibility study of transdermal buprenorphine versus transdermal fentanyl in the long-term management of persistent non-cancer pain. Pain Med. 2013;14(1):75–83.

    Article  PubMed  Google Scholar 

  71. Wild JE, Grond S, Kuperwasser B, Gilbert J, McCann B, Lange B, Steup A, Haufel T, Etropolski MS, Rauschkolb C, Lange R. Long-term safety and tolerability of tapentadol extended release for the management of chronic low back pain or osteoarthritis pain. Pain Pract. 2010;10(5):416–27.

    Article  PubMed  Google Scholar 

  72. Krebs EE, Becker WC, Zerzan J, Bair MJ, McCoy K, Hui S. Comparative mortality among Department of Veterans Affairs patients prescribed methadone or long-acting morphine for chronic pain. Pain. 2011;152(8):1789–95.

    Article  PubMed  Google Scholar 

  73. Naliboff BD, Wu SM, Schieffer B, Bolus R, Pham Q, Baria A, Aragaki D, Van Vort W, Davis F, Shekelle P. A randomized trial of 2 prescription strategies for opioid treatment of chronic nonmalignant pain. J Pain. 2011;12(2):288–96.

    Article  CAS  PubMed  Google Scholar 

  74. Portenoy RK, Messina J, Xie F, Peppin J. Fentanyl buccal tablet (FBT) for relief of breakthrough pain in opioid-treated patients with chronic low back pain: a randomized, placebo-controlled study. Curr Med Res Opin. 2007;23(1):223–33.

    Article  CAS  PubMed  Google Scholar 

  75. Ashburn MA, Slevin KA, Messina J, Xie F. The efficacy and safety of fentanyl buccal tablet compared with immediate-release oxycodone for the management of breakthrough pain in opioid-tolerant patients with chronic pain. Anesth Analg. 2011;112(3):693–702.

    Article  CAS  PubMed  Google Scholar 

  76. Davies A, Sitte T, Elsner F, Reale C, Espinosa J, Brooks D, Fallon M. Consistency of efficacy, patient acceptability, and nasal tolerability of fentanyl pectin nasal spray compared with immediate-release morphine sulfate in breakthrough cancer pain. J Pain Symptom Manage. 2011;41(2):358–66.

    Article  CAS  PubMed  Google Scholar 

  77. Webster LR, Slevin KA, Narayana A, Earl CQ, Yang R. Fentanyl buccal tablet compared with immediate-release oxycodone for the management of breakthrough pain in opioid-tolerant patients with chronic cancer and noncancer pain: a randomized, double-blind, crossover study followed by a 12-week open-label phase to evaluate patient outcomes. Pain Med. 2013;14(9):1332–45.

    Article  PubMed  Google Scholar 

  78. Cowan DT, Wilson-Barnett J, Griffiths P, Vaughan DJ, Gondhia A, Allan LG. A randomized, double-blind, placebo-controlled, cross-over pilot study to assess the effects of long-term opioid drug consumption and subsequent abstinence in chronic noncancer pain patients receiving controlled-release morphine. Pain Med. 2005;6(2):113–21.

    Article  PubMed  Google Scholar 

  79. Ralphs JA, Williams AC, Richardson PH, Pither CE, Nicholas MK. Opiate reduction in chronic pain patients: a comparison of patient-controlled reduction and staff controlled cocktail methods. Pain. 1994;56(3):279–88.

    Article  CAS  PubMed  Google Scholar 

  80. Tennant FS Jr, Rawson RA. Outpatient treatment of prescription opioid dependence: comparison of two methods. Arch Intern Med. 1982;142(10):1845–7.

    Article  PubMed  Google Scholar 

  81. Akbik H, Butler SF, Budman SH, Fernandez K, Katz NP, Jamison RN. Validation and clinical application of the screener and opioid assessment for patients with pain (SOAPP). J Pain Symptom Manag. 2006;32(3):287–93.

    Article  Google Scholar 

  82. Webster LR, Webster RM. Predicting aberrant behaviors in opioid-treated patients: preliminary validation of the opioid risk tool. Pain Med. 2005;6(6):432–42.

    Article  PubMed  Google Scholar 

  83. Jones T, Moore T, Levy JL, Daffron S, Browder JH, Allen L, Passik SD. A comparison of various risk screening methods in predicting discharge from opioid treatment. Clin J Pain. 2012;28(2):93–100.

    Article  PubMed  Google Scholar 

  84. Moore TM, Jones T, Browder JH, Daffron S, Passik SD. A comparison of common screening methods for predicting aberrant drug-related behavior among patients receiving opioids for chronic pain management. Pain Med. 2009;10(8):1426–33.

    Article  PubMed  Google Scholar 

  85. Noble M, Treadwell JR, Tregear SJ, Coates VH, Wiffen PJ, Akafomo C, Schoelles KM. Long-term opioid management for chronic noncancer pain. Cochrane Database Syst Rev. 2010. doi:https://doi.org/10.1002/14651858.CD006605.pub2.

  86. Alam A, Gomes T, Zheng H, Mamdani MM, Juurlink DN, Bell CM. Long-term analgesic use after low-risk surgery: a retrospective cohort study. Arch Intern Med. 2012;172(5):425–30.

    Article  PubMed  Google Scholar 

  87. Jones T, Lookatch S, Grant P, McIntyre J, Moore T. Further validation of an opioid risk assessment tool: the brief risk interview. J Opioid Manag. 2014;10(5):353–64.

    Article  PubMed  Google Scholar 

  88. Jones T, Moore T. Preliminary data on a new opioid risk assessment measure: the brief risk interview. J Opioid Manag. 2013;9(1):19–27.

    Article  PubMed  Google Scholar 

  89. • Miller M, Barber CW, Leatherman S, Fonda J, Hermos JA, Cho K, Gagnon DR. Prescription opioid duration of action and the risk of unintentional overdose among patients receiving opioid therapy. JAMA Intern Med. 2015;175(4):608–15. This study was published after the conclusion of the AHRQ review, but was included in the CDC review. In a cohort study of VA patients with chronic painful conditions, patients who were initiated on chronic opioid therapy using long-acting opioids were twice as likely to unintentionally overdose as compared to patients who were initiated using short-acting opioids.

  90. Ray WA, Chung CP, Murray KT, Cooper WO, Hall K, Stein CM. Out-of-hospital mortality among patients receiving methadone for noncancer pain. JAMA Intern Med. 2015;175(3):420–7.

    Article  PubMed  PubMed Central  Google Scholar 

  91. Rubinstein A, Carpenter DM. Elucidating risk factors for androgen deficiency associated with daily opioid use. Am J Med. 2014;127(12):1195–201.

    Article  CAS  PubMed  Google Scholar 

  92. Webster BS, Verma SK, Gatchel RJ. Relationship between early opioid prescribing for acute occupational low back pain and disability duration, medical costs, subsequent surgery and late opioid use. Spine (Phila Pa 1976). 2007;32(19):2127–32.

    Article  Google Scholar 

  93. Arai T, Kashimoto Y, Ukyo Y, Tominaga Y, Imanaka K. Two placebo-controlled, randomized withdrawal studies to evaluate the fentanyl 1 day patch in opioid-naive patients with chronic pain. Curr Med Res Opin. 2015;31(12):2207–18.

    Article  CAS  PubMed  Google Scholar 

  94. • Campbell G, Nielsen S, Larance B, Bruno R, Mattick R, Hall W, Lintzeris N, Cohen M, Smith K, Degenhardt L. Pharmaceutical opioid use and dependence among people living with chronic pain: associations observed within the pain and opioids in treatment (POINT) cohort. Pain Med. 2015;16(9):1745–58. This study was published after the conclusion of the CDC review. They showed a dose-dependent association between opioid use for chronic non-cancer pain and risk of aberrant behaviors in an Australian cohort.

  95. • Teng Z, Zhu Y, Wu F, Zhang X, Zhang C, Wang S, Zhang L. Opioids contribute to fracture risk: a meta-analysis of 8 cohort studies. PLoS One. 2015;10(6):e0128232. This study was published after the conclusion of the CDC review. They performed a literature search of cohort studies published before July 2014, and performed a meta-analysis that showed use of opioids conferred a relative risk for fractures of 1.88.

  96. • Grace PM, Strand KA, Galer EL, Urban DJ, Wang X, Baratta MV, Fabisiak TJ, Anderson ND, Cheng K, Greene LI, Berkelhammer D, Zhang Y, Ellis AL, Yin HH, Campeau S, Rice KC, Roth BL, Maier SF, Watkins LR. Morphine paradoxically prolongs neuropathic pain in rats by amplifying spinal NLRP3 inflammasome activation. Proc Natl Acad Sci USA. 2016;113(24):E3441–50. This translational study showed a possible mechanism by which opioid-induced hyperalgesia might occur after treatment of neuropathic injury with a short-course of morphine. The effects of the hyperalgesia lasted for several months after the morphine was discontinued, but could also be reversed with a specific ligand targeting the dorsal horn microglia and their expression of NLRP3 inflammasomes.

  97. • Hina N, Fletcher D, Poindessous-Jazat F, Martinez V. Hyperalgesia induced by low-dose opioid treatment before orthopaedic surgery: An observational case-control study. Eur J Anaesthesiol. 2015;32(4):255–61. This prospective observational study found that patients on opioid therapy (mean daily opioid use 42 MME) prior to orthopedic surgery had significantly higher hyperalgesia pre-operatively and had higher pain scores post-operatively in the recovery room. Patients on opioid therapy also used more morphine post-operatively, both in the recovery room and at 72 hours post-op.

  98. Ballantyne JC. Opioids in Chronic Nonterminal Pain. In: Ballantyne JC, editor. The Massachusetts general hospital handbook of pain management. 3rd ed. Philadelphia (PA): Lippincott Williams & Wilkins; 2006. p. 436–45.

    Google Scholar 

  99. Chen L, Vo T, Seefeld L, Malarick C, Houghton M, Ahmed S, Zhang Y, Cohen A, Retamozo C, St Hilaire K, Zhang V, Mao J. Lack of correlation between opioid dose adjustment and pain score change in a group of chronic pain patients. J Pain. 2013;14(4):384–92.

    Article  PubMed  PubMed Central  Google Scholar 

  100. Centers for Disease Control and Prevention. Common elements in guidelines for prescribing opioids for chronic pain. Atlanta: US Department of Health and Human Services, CDC; 2015.

    Google Scholar 

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Correspondence to Lucy L. Chen.

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Kenneth S. Tseng and Lucy L. Chen declare that they have no conflict of interest.

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Tseng, K.S., Chen, L.L. Opioid Therapy for Long-Term Pain Control in Non-terminal Patients. Curr Anesthesiol Rep 6, 305–313 (2016). https://doi.org/10.1007/s40140-016-0184-3

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