VA study: Ending long-term opioid use doesn't affect chronic pain

By Allen Cone  |  April 12, 2018 at 11:13 AM
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April 12 (UPI) -- Ending long-term use of opioids made no major difference to pain experienced by patients with chronic issues, according to a Veterans Administration study.

Researchers based their conclusions on the examination of the electronic health records of 600 patients with chronic pain issues in a national database maintained by the U.S. Department of Veterans Affairs.

Pain intensity fluctuated widely across time, the researchers report, but discontinuing opioids appeared to make no difference for patients' pain levels on average.

"This has the potential of adding to the pendulum swinging to get people off opioids," corresponding author Dr. Travis Lovejoy, an assistant professor of psychiatry in the OHSU School of Medicine and a clinical psychologist in the VA Portland Health Care System, said in a press release.

Lovejoy will present the findings, which have not yet been published, Thursday at the annual meeting of the Society of Behavioral Medicine in New Orleans.

"This study provides some of the first empirical evidence that pain intensity remains largely unchanged following discontinuation from long-term opioid therapy," researchers wrote in the study. "Clinicians should consider these findings when discussing with patients the risks of opioid therapy, as well as potential benefits of opioid tapering. As the medical culture shifts away from prescribing opioid therapy for chronic non-cancer pain, a growing number of patients currently prescribed LTOT will experience opioid discontinuation."

The researchers recommend other ways to control the pain, including providing patients who discontinue opioid therapy education and other options for treating pain.

Prescription opioid use has increased with an increased focus on helping patients to manage chronic pain. In 2016, 63,632 people died from overdoses in the United States with 66 percent involving a prescription or illicit opioid, according to the Centers for Disease Control and Prevention.

The researchers noted new prescribing guidelines call for physicians to reduce the use of opioids, but the long-term effect of opioids in pain management hadn't been studied much.

Lovejoy and fellow researchers from OHSU and Washington State University examined the health records of 7,247 who had been on long-term opioid therapy and then discontinued for at least 12 months.

Then they randomly sampled 300 patients with a substance use disorder diagnosis and propensity score-matched 300 patients without the diagnosis. Participants in the study had an average age of 55, and were 95 percent male and 71 percent non-Hispanic white.

Most of the patients had chronic musculoskeletal pain, with researchers tracking using self-reported pain intensity scores for 12 months before and 12 months after opioid therapy.

"Average pain intensity does not significantly worsen in the 12 months after discontinuation, and for some patients may in fact improve," the authors write.

The researchers caution, however, simply cutting off opioid treatment because it may lead to other issues, including going to doctors outside the VA system, suicidal thoughts or use of other substances such as heroin.

"There's still a lot to learn about the potential adverse effects of taking patients off opioids," Dr. Sterling McPherson, an associate professor and director of biostatistics and clinical trial design at Washington State University's College of Medicine, said in an OHSU release. "While there is a current push for policy change and legislation regarding opioids, we still don't fully understand the impact of taking patients off of long-term opioid therapy for treating chronic pain."

Researchers next plan more to track 1,000 patients over time through surveys and follow-up interviews.

"These data might help to normalize people's pain experience and educate them about the reality of their pain," Lovejoy said. "We found that their pain doesn't change. What we infer from that is, for people with chronic pain, it's never going to go to zero. Rather, it will continue to fluctuate over time as it did when they were still on opioids."

Another VA study published last month also found that opioids did not provide better pain relief than non-opioid alternatives such as acetaminophen to improve chronic back, hip or knee pain. The clinical trial compared opioids and non-opioid treatment of 240 patients over 12 months at 62 Veterans Affairs clinics in Minneapolis, Minn.

"Our findings, coupled with existing evidence on the long-term effectiveness of opioid therapy to reduce pain intensity, have significant clinical implications for the ways in which opioid discontinuation processes and conversations take place between patients and clinicians," the authors of the the latest study wrote.

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