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Evaluation of opioid use among patients with back disorders and arthritis

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Abstract

Purpose

Long-term opioid use for chronic pain has increased, but limited evidence exists on its benefits. Evaluation of long-term benefits in pain is based on patient-reported measures such as health-related quality of life (HRQoL). This study examined the long-term effects of opioid use on HRQoL and its subdomains in patients with back pain or arthritis by comparing opioid users to non-opioid users for three metrics: (1) any opioid use, (2) duration of opioid use, and (3) average daily morphine equivalent dose.

Methods

A nationally representative sample of cancer-free adults with chronic back pain or arthritis was selected. Using the 12-Item Short Form Survey, HRQoL measures of Mental Component Score (MCS), Physical Component Score (PCS), and individual subdomains were assessed at baseline and 1 year later. Opioid users were matched to non-opioid users in a 1:1 greedy match using propensity scores estimated based on many patient demographics and baseline HRQoL measures.

Results

At year one, PCS was significantly lower among opioid users, mostly driven by bodily pain subdomain; MCS was not different. Short-term opioid users (< 1 month) had higher MCS while long-term users (≥ 1 month) had lower PCS. Low-dose [< 20 morphine milligram equivalents (MME)/day] opioid use was associated with lower PCS, while no difference was found between high dose (≥ 20 MME/day) and non-opioid users. However, most differences were not clinically significant.

Conclusions

Long-term opioid use is not associated with improvements in HRQoL. Clinicians should carefully evaluate the need for opioid use, especially long-term use in managing chronic back pain and arthritis.

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Funding

Funding was provided by National Institute on Drug Abuse (Grant No. 1T32 DA 022981).

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Authors and Affiliations

  1. Division of Pharmaceutical Evaluation and Policy, Department of Pharmacy Practice, University of Arkansas for Medical Sciences College of Pharmacy, 4301 W. Markham St., # 522, Little Rock, AR, 72205, USA

    Corey J. Hayes, Nalin Payakachat & Chenghui Li

  2. Division of Health Services Research, Psychiatric Research Institute, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, USA

    Corey J. Hayes

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  1. Corey J. Hayes
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Correspondence to Chenghui Li.

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Conflict of interest

Dr. Hayes was supported by the Translational Training in Addiction [1T32 DA 022981]. Dr. Payakachat received a research grant from 7-Hybrid Cultivation, an honorarium for service as a paid consultant to Roche Ltd., service as a consultant to CBPartners, and ownership of stock in Pfizer. Drs. Hayes and Li declare that they have no conflict of interest.

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This article utilizes public-use data from the Agency for Healthcare Research and Quality (AHRQ). Therefore, it does not contain any studies with human participants or animals performed by any of the authors.

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Hayes, C.J., Payakachat, N. & Li, C. Evaluation of opioid use among patients with back disorders and arthritis. Qual Life Res 27, 3021–3035 (2018). https://doi.org/10.1007/s11136-018-1941-1

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