The increases in overdose fatalities associated with the use of long-term opioid medications has led to questions about their utility as a treatment for chronic pain conditions. Although there is little evidence for the beneficial effects of long-term opioid use in the treatment of chronic noncancer pain, the evidence of their adverse effects is clear.1 The findings in this issue of JAMA Neurology from Hoffman and colleagues2 further highlight the discrepancy between the increases in adverse effects from the use of long-term opioids and the lack of evidence of improvement when used to treat patients with polyneuropathy. In this retrospective study, the authors compared the outcomes of 2892 patients with polyneuropathy who had been treated with long-term opioids (≥90 days) with the outcomes of 14 435 age- and sex-matched patients who did not receive long-term opioid treatment (control group). It was noteworthy that patients were more likely to have been prescribed long-term opioid therapy for musculoskeletal pain (52.5%) as opposed to neuropathic pain (24.0%). Their study revealed much poorer outcomes for patients treated with long-term opioids, including reduced functional status and higher likelihood of depression, opioid dependence, or overdose, than for patients in the control group. The study was unable to match the groups for potential differences in severity of pain between them, which may have contributed to the poorer outcomes in those receiving long-term opioid treatment. There were also differences in medical comorbidities between the 2 groups, which were accounted for in a multivariate analysis. Regardless, their findings showed that the long-term use of opioids by patients with neuropathy did not improve any of the clinical or functional outcomes evaluated.
Volkow ND, Koroshetz W. Lack of Evidence for Benefit From Long-term Use of Opioid Analgesics for Patients With Neuropathy. JAMA Neurol. 2017;74(7):761–762. doi:10.1001/jamaneurol.2017.0466
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