Does Long-Term Opioid Treatment Improve Functional Status in Polyneuropathy?

Long-term treatment with opioids for patients with polyneuropathy does not improve functional status and is also linked with greater risk of adverse outcomes such as opioid dependency and overdose, according to a retrospective population-based cohort study.

Researchers from the Mayo Clinic in Rochester, Minnesota, examined data from prescriptions that patients with polyneuropathy and matched controls received between 2006 and 2010. Patients were followed up through November 25, 2016 to evaluate the duration of their exposure to opioids, among other outcomes. Long-term exposure to opioids was defined as 1 or multiple consecutive opioid prescriptions that led to 90 days or more of continuous opioid use.

There were 2,892 patients with polyneuropathy and 14,435 controls identified in the study. Of those with polyneuropathy, 18.8% received long-term opioids, compared with 5.4% of controls.

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Even after adjustment for medical comorbidities, patients with polyneuropathy who were receiving long-term opioids had modestly poorer results on multiple markers of functional status.

Polyneuropathy patients receiving long-term opioids were more likely to experience adverse outcomes, compared with individuals treated for a shorter period. These outcomes included depression (adjusted hazard ratio, 1.53; 95% confidence interval, 1.29-1.82), opioid dependence (adjusted hazard ratio, 2.85; 95% confidence interval, 1.54-5.47), and opioid overdose (adjusted hazard ratio, 5.12; 95% confidence interval, 1.63-19.62).

Although long-term opioid therapy may be the cause of the adverse outcomes, the researchers stated that other explanations, such as chronic pain itself, should not be ruled out.

The researchers believe their study’s findings could help in making treatment decisions and developing guidelines. “By showing that polyneuropathy increases the risk of long-term opioid therapy and that long-term opioid therapy is not associated with improved functional status but is associated with adverse outcomes, this study provides useful information to counsel patients with polyneuropathy who are considering or are already receiving opioid therapy,” they concluded.

—Lauren LeBano

Reference

Hoffman EM, Watson JC, Sauver JS. Association of long-term opioid therapy with functional status, adverse outcomes, and mortality among patients with polyneuropathy. JAMA Neurol. Published online May 22, 2017. doi:10.1001/jamaneurol.2017.0486.