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  • Study: Opioids Don't Improve Quality of Life for Individuals With Chronic Noncancer Pain

    Researchers have found that for individuals with chronic noncancer pain, opioids probably aren't delivering on what many presume to be their primary function—to improve overall quality of life by reducing pain and the emotional toll it takes.

    In a study published in Health Services Research (abstract only available for free) researchers tracked data from individuals who participated in the Medical Expenditure Panel Survey (MEPS), a project that collects health information by way of 5 rounds of surveys, each spanning a 2-year period. The survey asked about respondents' level of pain, use of opioids, and health-related quality of life (HRQoL) based on responses to 2 questionnaires, 1 on mental health and 1 on physical health.

    Authors of the study then focused on 5,876 respondents who reported chronic noncancer pain (CNCP), further dividing them into 3 groups: a no-use group, nonchronic opioid users (those who reported receiving at least 1 opioid prescription over a 12-month period but with a supply for fewer than 90 days), and chronic opioid users—those who reported receiving a prescription for opioids with a supply of 90 days or more in a 12-month period.

    After controlling for demographic variables, comorbidities, and diagnoses, researchers found that physical and mental health scores did not vary significantly among chronic, nonchronic, and no-use groups—a result indicating that the use of opioids did not improve HRQoL any better than no opioids for individuals experiencing the same kinds of pain.

    In fact, researchers point out, if there was any change to be noted, it would be that the chronic-use group reported slightly decreased physical health scores over time—but those changes did not result in a minimally clinically important difference from the other 2 groups.

    "The ultimate goal of using opioids for the treatment of CNCP is to ease the burden of pain and hopefully improve HRQoLs," authors write. "Overall, these results suggest that opioid use for CNCP is not associated with better HRQoL [as measured through the tests included in MEPS]. Considering the risk of development of opioid dependence and addiction and unclear benefit on HRQoL, clinicians should carefully evaluate a treatment goal and whether participants with CNCP should continue receiving opioid therapy."

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    APTA's award-winning #ChoosePT campaign is aimed at informing consumers that physical therapy is an effective alternative to drugs for the treatment of pain. Members can also learn more about the PT's role in pain management through offerings on PTNow, including a webpage with resources for pain management and an opioid awareness checklist.

    Comments

    • As described, this study’s methods are fatally flawed to such a degree that the results are practically meaningless. I’ll just mention 3: 1) it’s non-randomized. Choosing people from a subgroup, especially ones in which the study participants have chosen to join, like MEPS, already introduces bias to any results. 2) It’s based on self-reporting, the most unreliable form of data gathering due to reasons such as different people interpret questions slightly differently and therefore answer differently, when there really is no objective difference e.g.) what one person reports as a 5/10 pain level, someone else answers as a 7/10 (the difference theoretically could be influenced by each participants previous experience with pain. If you’ve never had a truly 10/10 pain experience, you’re more likely to rate your pain higher than someone who has had that experience. 3) which neatly leads to the third : They apparently didn’t control for the most important measure - average pain level for each of the groups. Lower prescriptions = lower pain levels. Higher prescriptions = higher pain levels. That the group with the highest amount of pain, those “chronically” taking opioids, showed the same HRQoLs as the occasional pain groups isn’t a mark against opioids not working, but rather a testament to the fact that even with chronic pain, opioids can help improve your HRQoLs to a the level of low-pain people. And by the way APTA, just because you provide a link to actual scientific, evidence-based research, doesn’t cover the fact that you’re misleading reader, either consciously or though ignorance.

      Posted by Ian Cameron on 5/19/2018 3:24 AM

    • While this might not be the most accurate study, there is a growing amount of evidence that we need to start looking for better alternatives.

      Posted by BackCoach on 1/3/2019 5:23 PM

    • I highly disagree with these statements. I have been off work for 6 years this November. I was on steroid treatment for Chrons Disease. I suffered a few stress fractures in my ribs, femur and metatarsals in 2005. I went on to work until one day I fell to the ground. Since that day in Dec. of 2013, I have undergone 17 surgeries to stabilize my fractures which included approximately 12 bone between each foot and ankle. My first surgery was in 2013 to fix my 3 displaced fractures of metatarsals in my right foot. It never healed. In the meantime my other extremity still had multiple fractures, but only one leg can be done at a time. My company basically fired immediately when they were aware. Since I was not there 90days yet I left without insurance. It took until 2015 to hetedicaid. I then had surgery on the left foot and ankle. The hardware cracked. He did the other foot and the hardware cracked. These were 6hour reconstructive surgeries. He retired. By the way he REFUSED to prescribe pain medication. The ain specialist he set me up with ordered EMLA cream as my treatment. The same pain sp. was to do my pain control after my 2nd reconstructive surgery. He never answered his pages, my own Ortho Dr wouldn't start the pump. I was told I could have Tylenol. On to my new surgeon. The left foot/ankle was so deformed and the pins were starting to come out through my skin. My PCP at the time told me I was a drug addict. His staff even told me I needed to go to rehab. I was on vicoprofen 7.5-200mg. I needed something stronger since the left foot was so bad. This surgeon removed the hardware immediately and o er 17surgeries in 2017 reconstructed my left foot. Currently my right has turned into a "rocker bottom" foot. This is the only foot I can put weight on. The hardware collapsed and at times I feel extreme pain as though the main broken bar moves up into my lower leg. There are pins, screws lying haphazardly in that foot now too. I am walking on my midfoot. The bones collapsed and it is basically a club foot now. The reconstructed foot has horrific neuropathic pain. During that reconstruction the surgeon found multiple bones that we're dead. I would imagine all the years before while this was occuring and all the doctors I saw treated me like an addict were wrong. When I had an external frame on the left leg with about 17 pins including one through my calcaneous and one pin through each to into a metatarsal, on through the tibia, and more. I was once again told by a pain Dr that should not hurt. By the way my husband had to turn the pins each night to help new bone grow since after all the hardware was taken out there was no longer enough bone to do surgery on. I tore my medial collateral ligament in my knee as well. Since I am on oral meds only it is hard to find añ empathetic, competent pain Dr. Not one of the 3 pain specialists I have seen over these 6 years ever wanted to see the painful area. When I asked one to look at my x-ray, already pulled up on my phone, he replied, "I'm not a radiologist." I am now confined to home and have a supposed pain physician.. His PA saw me and after that day it took him 8 days to respond to his calls re: me and my 85 yo arthritic mother. He finally prescribed her medication after my calling 10 times. He would not prescribe ANYTHING for me. I have been on PA in n medication since my 1st surgery. I have been asking to go down on my meds even. I actually feel methadone works the best and does noyt give you the up and down of pain, no pain or the addictive euphoric effects. He mentioned oxycontin. What???? Then his staff said he only prescribe Norco but didn't want to "harm"e. He is SUPPOSED to show up tomorrow? If anyone is aware of advocacy groups for patients with ttrue see ere pain, please forward to my email. In closing, I have been on no opioid medication for 14 days. I have not slept for maybe 2 hours a night, I haven't eaten and my sympathetic nervous system is not doing that bad, but not good. OH, I have been taking Motrin around the clock and Tylenol. I ASSURE you, these medications in no way work as good or better as opioids. What happened to the ...do not give Motrin to patients with heart disease and the dangers of renal failure and acetominophen toxicity to the liver? We're all those studies shown to be wrong now that there is an opioid epidemic. It's a shame that in trying to fix one thing, everyone forgot about people with true, severe pain. Maybe the next study to come out is that pain really doesn't exist and is a mental disorder. One last thing...I would that are such rigorous guidelines on prescribing, that there should be rigorous guidelines on how to treat pain patients. EverThe night prior to my appointment I can't sleep because I fear if I breathe they will say, can't see you anymore. Pain patients are not treated like any other patient. The contracts are humiliating. Sometes athe meds may not work If someone has true severe pain they will not think, ok, my contract says I can't take an extra pill earlier. I'll just lie here in excruciating pain. I have an undiagnosed sleep disorder that has progressed to my falling asleep standing up. I stopped my stronger medication and took a weaker one thinking it was the pain medicine. It was confirmed that is not what is doing it. Anyway I told my provider I did that. The next week I received a letter not to come to my next appointment, in fact it will written in red, do not see this patient. Toe that's disgusting. I wasn't going to keep falling hitting my head, injuring my neck and almost cracking my orbital bone. But since the contract says..,.I was endangering myself so I thought. The weaker med was the one they prescribed. They also said I will not be able to see any pain physician in their network, which is huge. It is also where I have my surgeries. Once they were upset because my short acting "as needed" med was not in my UDS. FINALLY in closing, who is looking out for the people with chronic, severe pain? If anyone knows, please let me know.

      Posted by Marie G Walsh, MD on 5/24/2019 12:43 AM

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