The Effectiveness and Risks of Long-Term Opioid Therapy for Chronic Pain: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop
Abstract
BACKGROUND: Increases in prescriptions of opioid medications for chronic pain have been accompanied by increases in opioid overdoses, abuse, and other harms and uncertainty about long-term effectiveness. PURPOSE: To evaluate evidence on the effectiveness and harms of long-term (>3 months) opioid therapy for chronic pain in adults. DATA SOURCES: MEDLINE, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, PsycINFO, and CINAHL (January 2008 through August 2014); relevant studies from a prior review; reference lists; and ClinicalTrials.gov. STUDY SELECTION: Randomized trials and observational studies that involved adults with chronic pain who were prescribed long-term opioid therapy and that evaluated opioid therapy versus placebo, no opioid, or nonopioid therapy; different opioid dosing strategies; or risk mitigation strategies. DATA EXTRACTION: Dual extraction and quality assessment. DATA SYNTHESIS: No study of opioid therapy versus no opioid therapy evaluated long-term (>1 year) outcomes related to pain, function, quality of life, opioid abuse, or addiction. Good- and fair-quality observational studies suggest that opioid therapy for chronic pain is associated with increased risk for overdose, opioid abuse, fractures, myocardial infarction, and markers of sexual dysfunction, although there are few studies for each of these outcomes; for some harms, higher doses are associated with increased risk. Evidence on the effectiveness and harms of different opioid dosing and risk mitigation strategies is limited. LIMITATIONS: Non-English-language articles were excluded, meta-analysis could not be done, and publication bias could not be assessed. No placebo-controlled trials met inclusion criteria, evidence was lacking for many comparisons and outcomes, and observational studies were limited in their ability to address potential confounding. CONCLUSION: Evidence is insufficient to determine the effectiveness of long-term opioid therapy for improving chronic pain and function. Evidence supports a dose-dependent risk for serious harms. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.
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Prescribed opioid medication misuse is alarmingly frequent in chronic pain patients.
“This finding is relevant given that there is a growing body of evidence to suggest that prescribed opioid medication misuse is alarmingly frequent in chronic pain patients [35,36,37,38].”
Medications such as opioids carry increased risks, including adverse side effects, opioid-induced hyperalgesia, abuse, and overdose.
“Moreover, medications such as opioids carry increased risks, including adverse side effects, opioid-induced hyperalgesia, abuse, and overdose [11–13].”
From Feasibility and Acceptability of an Abbreviated, Four-Week Mindfulness Program for Chronic Pain Management. (2020) · cites this paper as [11]
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- Authors
- Chou, R., Turner, J. A., Devine, E. B., Hansen, R. N., Sullivan, S. D., Blazina, I., Dana, T., Bougatsos, C., & Deyo, R. A.
- Affiliations
- Oregon Health & Science University (US)
- ORCID
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 2015-02-17
- Volume
- 162
- Issue
- 4
- Pages
- 276-286
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- OpenAlex
- W1965999023
- Cited by
- 1,606
- References
- 66
- Citations by year
- 2026: 68 · 2025: 101 · 2024: 123 · 2023: 127 · 2022: 135 · 2021: 157 · 2020: 180 · 2019: 175 · 2018: 171 · 2017: 163 · 2016: 143 · 2015: 59 · 2013: 1
- FWCI
- 25.74
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Public Health Service (HHSA 290-2012-00014I)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
- Keywords
- long-term opioid therapy, chronic pain, opioid overdose, opioid abuse, opioid use disorder, opioid-related harms, opioid dosing, risk mitigation strategies, fracture risk, myocardial infarction, sexual dysfunction, quality of life, functions, non-opioid analgesics
- MeSH terms
- Analgesics, Opioid, Drug Administration Schedule, Humans, Myocardial Infarction, Opioid-Related Disorders, Quality of Life, Risk Factors, Sexual Dysfunction, Physiological, Risk Assessment, Fractures, Bone, Chronic Pain, Drug Overdose
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