Opioids are controversial narcotic drugs known for their powerful pain-relieving (analgesic) properties. The therapeutic benefits of opioids have been recognized for thousands of years, with the use of the opium poppy chronicled throughout human history.

Within the body, opioids work by binding to special receptors within the central and peripheral nervous systems and the gastrointestinal tract, where they block the perception of pain, decrease reaction to pain, and improve pain tolerance. In addition, certain opioids can be used to treat cough and diarrhea.

Conditions Related to Opioids 

In spite of the risks of taking opioids, the properly managed, short-term medical use of these drugs is safe and rarely causes addiction. However, due to the dangers involved, opioids are not typically prescribed unless the provider feels the potential benefits outweigh the risks. In general, such indications include relief of pain from acute (short-term) conditions, surgeries and certain procedures. Opioids are not usually indicated for the management of chronic pain conditions, except in cases of palliative care (e.g., terminal cancers or degenerative diseases).

Conclusion 

 

Although opioids produce beneficial effects in many patients, they elicit certain side effects. These may include sedation, respiratory depression, and constipation. Opioids may also produce euphoria, which motivates some people to use them recreationally. Unfortunately, tolerance and dependence can develop with prolonged opioid use, and abrupt discontinuation of opioids can cause an unpleasant withdrawal syndrome. Talk to your doctor about whether or not opioid medications can benefit your condition.

Stopping long-term opioid therapy has no effect on pain

Patients may experience no discernible difference in their level of pain after discontinuing the long-term use of opioids, new research suggests.

Researchers examined the electronic health records of 600 patients in a national database maintained by the U.S. Department of Veterans Affairs. They found that patients, on average, experienced no difference in pain after they discontinued long-term use of opioids.

“Our data suggest that patients who discontinue opioid therapy will not experience worse pain,” the authors write. “Rather, their pain will remain similar or slightly improve, on average, relative to their levels of pain prior to discontinuation.”

The findings will be presented at the annual meeting of the Society of Behavioral Medicine April 11-14 in New Orleans.

“This has the potential of adding to the pendulum swinging to get people off opioids,” said corresponding author Travis Lovejoy, Ph.D., M.P.H., an assistant professor of psychiatry in the OHSU School of Medicine and a clinical psychologist in the VA Portland Health Care System.

The national opioid epidemic took hold in the 1990s, with an increased focus on helping patients to manage chronic pain. Pharmaceutical companies began marketing opioids to treat chronic pain beyond its previously established use in cancer treatment, palliative care and end-of-life care. However, widespread use of prescription opioids led to problems of misuse, addiction and overdoses. In 2016 alone, more than 60,000 people died from overdoses in the United States.

New prescribing guidelines are calling for physicians to reduce the use of opioids, yet little empirical data are available to gauge the long-term effect of opioids in pain management.

Lovejoy and fellow researchers from OHSU and Washington State University examined the health records of patients who had been on long-term opioid therapy and then discontinued for at least 12 months. The bulk of the patients suffered from chronic musculoskeletal pain and half were diagnosed with substance use disorder. The researchers then plotted each patient’s self-reported pain intensity scores for 12 months before and 12 months after their opioid therapy.

Although pain intensity fluctuated widely across time, discontinuing opioids appeared to make no difference for patients’ pain level plotted on average.

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

While the findings are striking – opioids appear to provide little benefit with significant harm in terms of the risk of addiction and overdose – Lovejoy cautioned that simply cutting off opioids may lead to other outcomes that weren’t measured in the study. For example, patients could migrate to another provider outside the VA system, they could experience suicidal ideation or they could seek illicit substances such as heroin.

“There’s still a lot to learn about the potential adverse effects of taking patients off opioids,” said lead author Sterling McPherson, Ph.D., associate professor and director of biostatistics and clinical trial design at Washington State University Elson S. Floyd College of Medicine. “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.”

Lovejoy said the next phase of research will enroll more than 1,000 patients and track them over time through survey methodologies and follow-up interviews to understand patients’ experiences with the opioid discontinuation process. In the meantime, he said, the new research may help patients gain a better understanding of their pain with and without opioids.

“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.”

The study comes on the heels of the results of a randomized clinical trial published in the Journal of the American Medical Association on March 6, which compared opioids and non-opioid treatment over 12 months for chronic back pain or hip or knee osteoarthritis pain. That study found that opioids did not provide better pain relief than non-opioid alternatives such as acetaminophen.

The new study adds to the pool of knowledge about the effectiveness of opioids.

“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 write.