Paduda: Newest Analysis on Continual Ache, Opioids and Different Medicine| Employees Compensation Information

By Joe Paduda

Thursday, April 1, 2021 | 85 | 0 | min read

Dr. Steve Feinberg referred me to two studies conducted by the Agency for Health Research and Quality on chronic pain, both systematic reviews (reviews of published studies on a specific topic). One focused on opioid treatments for chronic pain, the other on non-opioid pharmacological treatments.

Joe Paduda

The non-opioid research reviewed 190 studies, 185 of which were RCTs. The researchers concluded:

… the improvement in pain and function was small with specific antidepressants, moderate with specific antidepressants in diabetic peripheral neuropathy / post-therapeutic neuralgia and fibromyalgia, and low with nonsteroidal anti-inflammatory drugs (NSAIDs) in osteoarthritis and inflammatory arthritis.

One of the takeaways from the takeaway is that some medications have some benefits, often depending on the patient’s health.

Opioid treatment for chronic pain studies was based on a review of 162 studies: “115 randomized controlled trials [the gold standard of clinical research], 40 observational studies and 7 predictive accuracy studies. “

Note that for research purposes, chronic pain is described as pain that lasts for more than three to six months.

There was more credible research evaluating short-term outcomes compared to longer-term outcomes, but there were no RCTs comparing medium- or longer-term opioids with placebo.

Takeaways include (and these are direct quotes):

  • There were no differences between opioids and non-opioid drugs in terms of pain, function, or other short-term outcomes.
  • Opioids were associated with little benefit compared to placebo in terms of short-term pain, function, and sleep quality.
  • There was a small dose-related effect on pain and the effects were attenuated with longer (three to six months) versus shorter (one to three months) follow-up periods.

Most worryingly, “There is evidence of an increased risk of serious harm that appears to be dose-dependent.” The higher the dose, the greater the risk.

This crossed my desk the day before a good friend’s brother died from an apparent opioid overdose, adding a painful exclamation point to the conclusion of the study.

Extensive research in Australia focusing on long-term opioid use in patients with chronic, non-cancer pain, found that:

Despite limited evidence of effectiveness, long-term opioid prescribing for chronic non-cancer pain has increased significantly in several countries.

Here’s the thing: the research we have clearly shows that the risk of opioids is high and the benefits are limited. However, there is not enough research on the effectiveness of long-term opioid use for chronic pain.

Anecdotes suggest that some patients can handle opioids well for extended periods of time.

However, the evidence we have suggests that overall effectiveness is limited at best and the risks are high. Fortunately, more research on opioid efficacy, risks, and chronic pain has already been funded.

What we cannot do is force opioid patients; that is dangerous and unethical.

what does that mean to you?

Opioids have their place, but be very careful, especially when used long-term. Life is precious.

Joseph Paduda is a co-owner of CompPharma, a consulting firm focused on improving pharmacy programs in employee compensation. This column is republished from his Managed Care Matters blog with his permission.

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