Opioid Deprescribing: Difference between revisions
No edit summary |
No edit summary |
||
| Line 6: | Line 6: | ||
<gallery> | <gallery> | ||
File:SPACE BPI 2018.png | File:SPACE BPI 2018.png|Brief Pain Inventory (BPI) over 12 months | ||
File:SPACE BPI interference 2018.png | File:SPACE BPI interference 2018.png|Pain Interference over 12 months | ||
</gallery> | </gallery> | ||
| Line 13: | Line 13: | ||
<gallery> | <gallery> | ||
File:Opioid discontinuation mcpherson overall 2018.png | File:Opioid discontinuation mcpherson overall 2018.png|Pain over | ||
File:Opioid discontinuation mcpherson 2018.png | File:Opioid discontinuation mcpherson 2018.png|Pain over time differences between groups | ||
</gallery> | </gallery> | ||
==References== | ==References== | ||
Revision as of 17:29, 3 April 2021
There is clear evidence that opioids are not effective for long term chronic non-cancer pain. In fact, patients are worse of in terms of pain levels with opioid use potentially due to opioid hyperalgesia. Furthermore opioid use has real harm.[1] Discontinuation does not cause any changes in pain intensity.[2]
Evidence
A landmark study was published in 2018 by Krebs et al - the SPACE study. It was a pragmatic randomised controlled trial comparing opioid versus non opioid analgesics for 12 months in primary care. Participants were 240 VA patients with moderate to severe chronic back pain or knee/hip OA, and not on opioids. The mean pain intensity initially was 5.4 in both arms. Pain scores at 1 year was worse in the opioid arm (4.0) than non opioid (3.5) (P=0.034). There was no difference in pain interference, and adverse effects were worse in opioid group (P=0.03).[1]
Brief Pain Inventory (BPI) over 12 months
Pain Interference over 12 months
McPherson et al studied changes in pain intensity over 12 months after opioid discontinuation in chronic non-cancer pain. Participants were 551 VA patients, with 87% musculoskeletal pain, 11% headaches, and 6% neuropathic pain. Mean estimated pain at the time of opioid discontinuation was 4.9. There was no statistically significant decline in pain intensity over 12 months after discontinuation. Patients were statistically divided into four groups - no pain (average pain 0.37), mild pain (3.9), moderate pain (6.33), severe pain (8.23). Pain trajectories in each category were similar to the overall results. Patients with mild and moderate pain had the greatest pain reductions after discontinuation. On average, pain intensity after discontinuation did not worsen for patients, and many slightly improved.[2]
Pain over
Pain over time differences between groups
References
- ↑ 1.0 1.1 Krebs et al.. Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain: The SPACE Randomized Clinical Trial. JAMA 2018. 319:872-882. PMID: 29509867. DOI. Full Text.
- ↑ 2.0 2.1 McPherson et al.. Changes in pain intensity after discontinuation of long-term opioid therapy for chronic noncancer pain. Pain 2018. 159:2097-2104. PMID: 29905648. DOI. Full Text.
Literature Review
Literature Review
- Reviews from the last 7 years: review articles, free review articles, systematic reviews, meta-analyses, NCBI Bookshelf
- Articles from all years: PubMed search, Google Scholar search.
- TRIP Database: clinical publications about evidence-based medicine.
- Other Wikis: Radiopaedia, Wikipedia Search, Wikipedia I Feel Lucky, Orthobullets,
