Limited Benefit of Long-Term Narcotic Use
STUDIES SHOW LIMITED BENEFIT OF LONG-TERM NARCOTIC USE
For years it was reported that physicians were undertreating pain. The pendulum has clearly swung to the opposite extreme and opioids are regularly used for chronic non-malignant pain. At issue is the lack of scientific evidence to support the use of narcotics in this patient population.
The inherent ethical obligation to prescribe opioids long-term has limited support from randomized controlled trials. Short term studies show some temporary pain relief, however there is limited evidence of improved function or quality of life. According to Eriksen et al (Pain, 2006, 125:172-9), opioid use was associated with higher pain levels, lack of physical activity, a lesser quality of life and higher rates of unemployment.
There appears to be a small group of patients that do well with long-term opioids but the difficulty is identifying those patients. Sullivan and Ballantyne (Archives of Internal Medicine, 2012, 172:433-4) reported patients with localized pain, limited comorbidities (medical and psychological), and an adequate support system tend to tolerate long-term narcotic therapy. Identifying these patients can be a challenge, along with getting all patients to understand that narcotics in the chronic pain setting are often associated with poorer outcomes. Alternative treatments such as non-narcotic medication, physical therapy, TENS unit, regular physical activity, biofeedback, weight loss and proper diet can be utilized to improve function and reduce pain without the potential complications of opioid therapy.
For more information about the study conclusions on opiod use for pain, go to: LINK
For more information about Sullivan and Ballantyne's study, go to: LINK
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