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Effectiveness of Opioids for Chronic Noncancer Pain: A Two-Year Multicenter, Prospective Cohort Study With Propensity Score Matching

  • Dalila R. Veiga
    Correspondence
    Address reprint requests to Dalila Veiga, MD, Rua Maria Peregrina de Sousa, 77, 4250-095 Porto, Portugal.
    Affiliations
    Anesthesiology Department, Chronic Pain Center, Centro Hospitalar Universitário do Porto

    Largo do Prof. Abel Salazar, Porto, Portugal

    CINTESIS, Center for Health Technology and Services Research, Faculdade de Medicina da Universidade do Porto
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  • Matilde Monteiro-Soares
    Affiliations
    CINTESIS, Center for Health Technology and Services Research, Faculdade de Medicina da Universidade do Porto

    MEDCIDS, Departamento de Medicina da Comunidade Informação e Decisão em Saúde, Faculdade de Medicina da Universidade do Porto
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  • Liliane Mendonça
    Affiliations
    Centro Nacional de Observação em Dor, OBSERVDOR

    Alameda Prof. Hernâni Monteiro, Porto, Portugal
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  • Rute Sampaio
    Affiliations
    Alameda Prof. Hernâni Monteiro, Porto, Portugal

    Departamento de Biomedicina, Unidade de Biologia Experimental, Faculdade de Medicina da Universidade do Porto, Porto, Portugal

    i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal/IBMC, Instituto de Biologia Molecular e Celular, Universidade do Porto, Porto, Portugal
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  • José M. Castro-Lopes
    Affiliations
    Alameda Prof. Hernâni Monteiro, Porto, Portugal

    Departamento de Biomedicina, Unidade de Biologia Experimental, Faculdade de Medicina da Universidade do Porto, Porto, Portugal

    i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal/IBMC, Instituto de Biologia Molecular e Celular, Universidade do Porto, Porto, Portugal

    Centro Nacional de Observação em Dor, OBSERVDOR, Porto, Portugal
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  • Luís F. Azevedo
    Affiliations
    CINTESIS, Center for Health Technology and Services Research, Faculdade de Medicina da Universidade do Porto

    MEDCIDS, Departamento de Medicina da Comunidade Informação e Decisão em Saúde, Faculdade de Medicina da Universidade do Porto

    Alameda Prof. Hernâni Monteiro, Porto, Portugal

    Centro Nacional de Observação em Dor, OBSERVDOR, Porto, Portugal
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Published:December 28, 2018DOI:https://doi.org/10.1016/j.jpain.2018.12.007

      Highlights

      • Our study evaluates opioid effectiveness on chronic noncancer pain over 2 years of follow-up.
      • Opioid users reported no improvement in functional outcomes and quality of life.
      • Patients’ selection and outcome assessment is crucial to promote proper opioid use.

      Abstract

      Opioid use in chronic non cancer pain (CNCP) is still controversial regarding their effectiveness and safety. We conducted a 2-year prospective cohort study in 4 multidisciplinary chronic pain clinics to assess long-term opioid effectiveness in CNCP patients. All adult CNCP patients consecutively admitted to their first consultation were recruited. Demographic and clinical data were collected, and propensity score matching was used to adjust for differences between opioid users and nonusers. The Brief Pain Inventory and the Short version of Treatment Outcomes in Pain Survey were used to measure pain outcomes and quality of life. A total of 529 subjects were matched and included in our analysis. Rate of prescription opioid use was 59.7% at baseline, which increased to 70.3% over 2 years, of which 42.7% of the prescriptions were for strong opioids. Opioid users reported no improvement regarding pain symptoms, physical function, emotional function, and social/familiar disability. Opioid users reported higher satisfaction with care and outcomes at 1 year of follow-up, but at 2 years, they only reported improvement in satisfaction with outcomes. Opioids have shown limited effectiveness in long-term CNCP management, as opioid users presented no improvements regarding functional outcomes and quality of life. These findings emphasize the need for proper selection and outcome assessment of CNCP patients prescribed opioids.

      Perspective

      This study adds important additional evidence concerning the controversial use of opioids in CNCP management. Opioid users presented no improvement regarding pain relief, functional outcomes and quality of life over 2 years of follow-up. Therefore, our results support and highlight the limited effectiveness of opioids in long-term CNCP management.

      Key words

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