Opioids: Current Science
James B. Talmage
Search for other papers by James B. Talmage in
Current site
Google Scholar
PubMed
Close
and
Robert B. Snyder
Search for other papers by Robert B. Snyder in
Current site
Google Scholar
PubMed
Close
Restricted access

Abstract

Evidence shows that chronic opioid therapy is usually not beneficial; weaning patients off opioids many times results in less pain and better function, and opioid-induced hyperalgesia is real and frequent. Further evidence suggests that surgical outcomes are better if patients are weaned off opioids before surgery, and that the chronic use of opioids may adversely alter the assessment of maximum medical improvement (MMI).

  • 1.

    Mattson CL, Tanz LJ, Quinn K, et al. Trends and geographic patterns in drug and synthetic opioid overdose deaths—United States, 2013-2019. MMWR. 2021;70(6):202207.

    • Search Google Scholar
    • Export Citation
  • 2.

    Volkow N, Benveniste H, McLellan AT. Use and misuse of opioids in chronic pain. Ann Rev Med. 2018;69:451465.

  • 3.

    Barth RJ. Prescription narcotics: an obstacle to maximum medical improvement. AMA Guides Newsletter. March/April 2011:17.

  • 4.

    Eriksen J, Sjøgren P, Bruera E, et al. Critical issue on opioids in chronic noncancer pain: an epidemiological study. Pain. 2006;125: 172179.

    • Search Google Scholar
    • Export Citation
  • 5.

    Deyo RA, Von Korff M, Duhrkoop D. State of the art review: opioids for low back pain. BMJ. 2015;350:g6380.

  • 6.

    Reinecke H, Weber C, Lange K, et al. Analgesic efficacy of opioids in chronic pain: recent meta-analyses. Br J Pharmacol. 2015;172: 324333.

    • Search Google Scholar
    • Export Citation
  • 7.

    Chou R, Turner JA, Devine EB, et al. The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Works. Ann Intern Med. 2015;162:276286.

    • Search Google Scholar
    • Export Citation
  • 8.

    Shaheed CA, Maher CG, Williams KA, et al. Efficacy, tolerability, and dose-dependent effects of opioid analgesics for low back pain: a systematic review and meta-analysis. JAMA Intern Med. 2016;176(7):958968.

    • Search Google Scholar
    • Export Citation
  • 9.

    Ballantyne JC. Avoiding opioid analgesics for treatment of chronic low back pain. JAMA Intern Med. 2016;315(22):24592460.

  • 10.

    Els C, Jackson TD, Kunyk D, et al. Adverse events associated with medium- and long-term use of opioids for chronic non-cancer pain: an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2017;10(10):CD012509.

    • Search Google Scholar
    • Export Citation
  • 11.

    Busse JW, Wang L, Kamaleldin M, et al. Opioids for chronic noncancer pain: a systematic review and meta-analysis. JAMA. 2018;320(23):24482460.

    • Search Google Scholar
    • Export Citation
  • 12.

    Agency for Healthcare Research and Quality (AHRQ). 2020. Comprehensive Effectiveness Review #229: Opioid Treatments for Chronic Pain. Accessed Feb 20, 2021. https://effectivehealthcare.ahrq.gov/sites/default/files/pdf/opioids-chronic-pain.pdf.

    • Search Google Scholar
    • Export Citation
  • 13.

    Klimas J, Gorfinkel L, Fairbairn N, et al. Strategies to identify patient risks of prescription opioid addiction when initiating opioids for pain: a systematic review. JAMA Netw Open. 2019;2(5):e193365. doi: 10.1001/jamanetworkopen.2019.3365.

    • Search Google Scholar
    • Export Citation
  • 14.

    Frank JW, Lovejoy TI, Becker WC, et al. Patient outcomes in dose reduction or discontinuation of long-term opioid therapy. Ann Intern Med. 2017;167:181191.

    • Search Google Scholar
    • Export Citation
  • 15.

    Mackey K, Anderson J, Boiurne D, et al. Benefits and harms of long-term opioid dose reduction or discontinuation in patients with chronic pain: a rapid review. J Gen Intern Med. 2020;35(Suppl 3):S935S944.

    • Search Google Scholar
    • Export Citation
  • 16.

    Huffman K, Rush TE, Fan Y, et al. Sustained improvements in pain, mood, function and opioid use post interdisciplinary pain rehabilitation in patients weaned from high and low dose chronic opioid therapy. Pain. 2017;158:13801394.

    • Search Google Scholar
    • Export Citation
  • 17.

    Lee M, Silverman S, Hansen H, et al. A comprehensive review of opioid-induced hyperalgesia. Pain Physician. 2011;14: 145161.

  • 18.

    Trang, T, Al-Hasani R, Salvemini D, et al. Pain and poppies: the good, the bad, and the ugly of opioid analgesics. J Neuroscience. 2015;35(41):1387913888.

    • Search Google Scholar
    • Export Citation
  • 19.

    Rivat C, Ballantyne J. The dark side of opioids in pain management: basic science explains clinical observations. Pain Reports. 2016;1:e570.

    • Search Google Scholar
    • Export Citation
  • 20.

    Colvin LA, Bull F, Hales TG. Postoperative pain management and opioids 3: Perioperative opioid analgesia—when is enough too much? A review of opioid-induced tolerance and hyperalgesia. Lancet. 2019;393:15581568.

    • Search Google Scholar
    • Export Citation
  • 21.

    Higgins C, Smith BH, Matthews K. Evidence of opioid-induced hyperalgesia in clinical populations after chronic opioid exposure: a systematic review and meta-analysis. Br J Anaesth. 2019;122(6): e114e126.

    • Search Google Scholar
    • Export Citation
  • 22.

    Compton PA, Wasser TE, Cheatle MD. Increased experimental pain sensitivity in chronic pain patients who developed opioid use disorder. Clin J Pain. 2020;36:667674.

    • Search Google Scholar
    • Export Citation
  • 23.

    Glare P, Aubrey KR, Myles PS. Postoperative pain management and opioids 1: Transitions from acute to chronic pain after surgery. Lancet. 2019;393:15371546.

    • Search Google Scholar
    • Export Citation
  • 24.

    Hayhurst CJ, Durieux ME. Differential opioid tolerance and opioid-induced hyperalgesia: a clinical reality. Anesthesiology. 2016;124(2):483488.

    • Search Google Scholar
    • Export Citation
  • 25.

    Rosen IM, Aurora, RN, Kirsch DB, et al. Chronic opioid therapy and sleep: an American Academy of Sleep Medicine position statement. J Clin Sleep Med. 2019;15(11):16711673. doi: 10.5664/jcsm.8062.

    • Search Google Scholar
    • Export Citation
  • 26.

    Salas J, Scherrer JF, Schneider FD, et al. New-onset depression following stable, slow, and rapid increase of prescription opioid dose escalation. Pain. 2017;158:306312.

    • Search Google Scholar
    • Export Citation
  • 27.

    Bekeris J, Wilson LA, Fiasconaro M, et al. New onset depression and anxiety after spinal fusion surgery: incidence and risk factors. Spine. 2020;45:11611169.

    • Search Google Scholar
    • Export Citation
  • 28.

    Kaafarani HMA, Han K, El Moheb M, et al. Opioids after surgery in the United States versus the rest of the World: The International Patterns of Opioid Prescribing (iPOP) Multicenter Study. Ann Surg. 2020;272:879886.

    • Search Google Scholar
    • Export Citation
  • 29.

    El Moheb M, Mokhtari A, Han K, et al. Pain or no pain, we will give you opioids: relationship between number of opioid pills prescribed and severity of pain after operation in U.S. vs non-U.S. patients. J Am Coll Surg. 2020;231:639648.

    • Search Google Scholar
    • Export Citation
  • 30.

    Ladha KS, Neuman MD, Broms G, et al. Opioid prescribing after surgery in the United States, Canada, and Sweden. JAMA Netw Open. 2019;2(9):e1910734.

    • Search Google Scholar
    • Export Citation
  • 31.

    Yerneni K, Nichols N. Abecassis ZA, et al. Preoperative opioid use and clinical outcomes in spine surgery: a systematic review. Neurosurgery. 2020;86(6):E490E507.

    • Search Google Scholar
    • Export Citation
  • 32.

    Samuel AM, Lovecchio FC, Premkumar A, et al. Use of higher-strength opioids has a dose-dependent association with reoperations after lumbar decompression and interbody fusion surgery. Spine. 2021;46:E203E212.

    • Search Google Scholar
    • Export Citation
  • 33.

    Faour M, Anderson JT, Haas AR, et al. Prolonged preoperative opioid therapy associated with poor return to work rates after single-level cervical fusion for radiculopathy for patients receiving workers' compensation benefits. Spine. 2017;42:E104E110.

    • Search Google Scholar
    • Export Citation
  • 34.

    Kalakoti P, Hendrickson NR, Bedard NA, et al. Opioid utilization following lumbar arthrodesis. Spine. 2018;43:12081216.

  • 35.

    Schoenfeld AJ, Belmont PJ, Blucher JA, et al. Sustained preoperative opioid use is a predictor of continued use following spine surgery. J Bone Joint Surg. 2018;100:914921.

    • Search Google Scholar
    • Export Citation
  • 36.

    Hills JM, Pennings JS, Archer KR, et al. Preoperative opioids and 1-year patient-reported outcomes after spine surgery. Spine. 2019;44:887895.

    • Search Google Scholar
    • Export Citation
  • 37.

    Kalakoti P, Vokkmar AJ, Bedard NA, et al. Preoperative chronic opioid therapy negatively impacts long-term outcomes following cervical fusion surgery. Spine. 2019;44(18):12791286.

    • Search Google Scholar
    • Export Citation
  • 38.

    Pirkle S, Reddy S, Bhattacharjee S, et al. Chronic opioid use is associated with surgical site infection after lumbar fusion. Spine. 2020;45:837842.

    • Search Google Scholar
    • Export Citation
  • 39.

    Hills JM, Carlile CR, Archer KR, et al. Duration and dosage of opioids after spine surgery: implications on outcomes at 1 year. Spine. 2020;45:10811088.

    • Search Google Scholar
    • Export Citation
  • 40.

    Reyes AA, Canseco JA, Mangan JJ, et al. Risk factors for prolonged opioid use and effects of opioid tolerance on clinical outcomes after anterior cervical discectomy and fusion surgery. Spine. 2020;45:968975.

    • Search Google Scholar
    • Export Citation
  • 41.

    Berkman RA, Wright AH, Sivaganesan A. Opioid-free spine surgery: a prospective study of 244 consecutive cases by a single surgeon. Spine J. 2020;20:11761183.

    • Search Google Scholar
    • Export Citation
  • 42.

    Armaghani SJ, Lee DS, Bible JE, et al. Preoperative opioid use and its association with perioperative opioid demand and postoperative opioid independence in patients undergoing spine surgery. Spine. 2014;39:E1524E1530.

    • Search Google Scholar
    • Export Citation
  • 43.

    Jain N, Brock JL, Malik AT, et al. Prediction of complications, readmissions, and revision surgery based on the duration of pre-operative opioid use. J Bone Joint Surg. 2019;101:384391.

    • Search Google Scholar
    • Export Citation
  • 44.

    Jain N, Phillips FM, Malik AT, et al. Preoperative opioid weaning before major spinal fusion. Spine. 2021;46(2):8086.

  • 45.

    Morris BJ, Mir HR. The opioid epidemic: impact on orthopaedic surgery. J Am Acad Orthop Surg. 2015;23:267271.

  • 46.

    Brat GA, Agniel D, Bearm A, et al. Postsurgical prescriptions for opioid naive patients and association with overdose and misuse: retrospective cohort study. BMJ. 2018;360:j5790.

    • Search Google Scholar
    • Export Citation
  • 47.

    Sabatino MJ, Kunkel ST, Ramkumar DB, et al. Excess opioid medication and variation in prescribing patterns following common orthopaedic procedures. J Bone Joint Surg Am. 2018;100:180188.

    • Search Google Scholar
    • Export Citation
  • 48.

    Basilico M, Bhashyam AR, Harris MB, et al. Prescription opioid type and likelihood of prolonged opioid use after orthopaedic surgery. J Am Acad Orthop Surg. 2019;27:e423e429.

    • Search Google Scholar
    • Export Citation
  • 49.

    Lovecchio F, Derman P, Stepan J, et al. Support for safer opioid prescribing practices: a catalog of published use after orthopaedic surgery. J Bone Joint Surg. 2017;99:19451955.

    • Search Google Scholar
    • Export Citation
  • 50.

    Agrawal Y, Smith RM, Garbyz DS, et al. Current concept review — opioids in arthroplasty: mind the gap between North America and the rest of the world. J Bone Joint Surg. 2018;100:21622171.

    • Search Google Scholar
    • Export Citation
  • 51.

    Bedard NA, DeMik DE, Dowdle SB, et al. Preoperative opioid use and its association with early revision of total knee arthroplasty. J Arthroplasty. 2018 Nov;33(11):35203523.

    • Search Google Scholar
    • Export Citation
  • 52.

    Goplen CM, Verbeek W, Kang SH, et al. Preoperative opioid use is associated with worse patient outcomes after total joint arthroplasty: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2019; 20(1):234.

    • Search Google Scholar
    • Export Citation
  • 53.

    Singh A, Chan PH, Prentice HA, et al. Postoperative opioid utilization associated with revision risk following primary shoulder arthroplasty. J Shoulder Elbow Surg. 2021;5:10341041.

    • Search Google Scholar
    • Export Citation
  • 54.

    Pitta M, Esposito CI, Li Z, et al. Failure after modern total knee arthroplasty: a prospective study of 18,065 knees. J Arthroplasty. 2018;3(2):407414.

    • Search Google Scholar
    • Export Citation
  • 55.

    Sun D, Cusano A, Harrington MA, et al. Combating the opioid epidemic: experience with a single prescription for total joint arthroplasty. Arthroplast Today. 2020;6:668671.

    • Search Google Scholar
    • Export Citation
  • 56.

    Engle AM, Chen Y, Marascalchi B, et al. Lumbosacral radiculopathy; inciting events and their association with epidural steroid injection outcomes. Pain Med. 2019;20(12):23602370.

    • Search Google Scholar
    • Export Citation
  • 57.

    Harris IA, Sidhu V, Mittal R, et al. Surgery for chronic musculo-skeletal pain: the question of evidence. Pain. 2020;161:S95S103.

  • 58.

    Krebs EE, Gravely A, Nugent S, 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(9):872882.

    • Search Google Scholar
    • Export Citation
  • 59.

    RAND Corporation. Effects of medication assisted treatment (MAT) for opioid use disorder on functional outcomes: a systematic review. Accessed Feb 20, 2021. https://www.rand.org/pubs/research_reports/RR2108.html.

    • Search Google Scholar
    • Export Citation
  • 60.

    Pearce LA, Min JE, Piske M, et al. Opioid agonist treatment and risk of mortality during opioid overdose public health emergency: population based retrospective cohort study. BMJ. 2020;368:m772.

    • Search Google Scholar
    • Export Citation
  • 61.

    Oesterle TS, Thusius NJ, Rummans TA, et al. Medication assisted treatment for opioid use Disorder. Mayo Clin Proc. 2019; 94(10): 20722086.

    • Search Google Scholar
    • Export Citation
  • 62.

    Mark TL, Parish W. Opioid medication discontinuation and risk of adverse opioid-related healthcare events. J of Subst Abuse Treat. 2019;103:5863.

    • Search Google Scholar
    • Export Citation
  • 63.

    Veterans Administration: Opioid Taper Decision Tool. Accessed Feb 20, 2021. https://www.pbm.va.gov/AcademicDetailingService/Documents/Pain_Opioid_Taper_Tool_IB_10_939_P96820.pdf.

    • Search Google Scholar
    • Export Citation
  • 64.

    CDC 2016: Pocket Guide: Tapering Opioids for Chronic Pain. Accessed Feb 20, 2021. https://www.cdc.gov/drugoverdose/pdf/clinical_pocket_guide_tapering-a.pdf.

    • Search Google Scholar
    • Export Citation
  • 65.

    CDC Guideline for Prescribing Opioids for Chronic Pain—United States 2016. Accessed Feb 20, 2021. https://www.cdc.gov/mmwr/volumes/65/rr/pdfs/rr6501e1.pdf.

    • Search Google Scholar
    • Export Citation
  • 66.

    US Department of Health and Human Services. 2019: HHS Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics. Accessed Feb 20, 2021. https://www.hhs.gov/opioids/sites/default/files/2019-10/Dosage_Reduction_Discontinuation.pdf.

    • Search Google Scholar
    • Export Citation
  • 67.

    Covington EC, Argoff CE, Ballantyne JC, et al. Ensuring patient protections when tapering opioids: consensus panel recommendations. Mayo Clin Proc. 2020;95(10):21552171.

    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 1458 1458 1184
Full Text Views 39 39 0
PDF Downloads 0 0 0
Save