Early opioid use for chronic non-cancer pain minimally affects quality of life, prompting caution in prescription with a careful consideration of benefits versus long-term risks.

The following is a summary of “Does opioid therapy enhance quality of life in patients suffering from chronic non-malignant pain? A systematic review and meta-analysis,” published in the November 2023 issue of Pain by Kraft et al.

Researchers performed a retrospective study to determine if opioids enhance HRQL in non-malignant chronic pain, aiming to inform clinical practice.

They searched PubMed, EMBASE, and CENTRAL (June 2020) for double-blind RCTs comparing opioid therapy to placebo and evaluating an HRQL questionnaire, including both a qualitative vote counting approach and a meta-analysis with the Short Form Health Survey (SF-36), EQ-5D questionnaire, and the pain interference scale of Brief Pain Inventory (BPI).

The results showed 35 RCTs, with a majority showing a positive impact of opioids on EQ-5D, BPI, and the Physical Component Score (PCS) of SF-36 compared to placebo. Meta-analysis for PCS demonstrated a mean difference of 1.82 [CI: 1.32, 2.32], and for EQ-5D, a significant advantage of 0.06 [0.00, 0.12]. Evaluation of the Mental Component Score (MCS) of SF-36 in qualitative analysis revealed no clear trend. No significant differences in MCS were observed (MD: 0.65 [-0.43, 1.73]), but the opioid group showed a slightly higher premature dropout rate (risk difference: 0.04 [0.00, 0.07], P=.07). Overall evidence is graded as low to medium.

Investigators concluded that early opioid use for chronic non-cancer pain had minimal impact on quality of life. Prescribe cautiously and weigh benefits against long-term risks.

Source: journals.sagepub.com/doi/full/10.1177/20494637231216352