Opioids for Chronic Nonterminal Pain
Opioids for Chronic Nonterminal Pain
Many medical practitioners believe that improvements in function and quality of life are needed for long-term opioid treatment to be deemed a success, although a few believe that good pain relief, regardless of other markers of successful treatment, is enough to justify continued opioid treatment. Despite the importance of this debate, the literature provides surprisingly little evidence on nonanalgesia-related outcomes. Some randomized trials combine assessments of pain relief with assessment of function, but the focus of these assessments tends to vary with the primary interest of the investigators. While some investigators demonstrate improvements in limited measures of function, others find no difference ( Table 1 ). Observational trials contribute little in the way of assessment of function. Although some report improvement in broad measures such as ability to perform activities of daily living and return to work, others do not comment. Few opioid trials measure quality of life, which is again surprising given the importance of this factor and the fact that there are several validated measurement instruments available.
Several studies have looked specifically at cognitive function, including the ability to drive and operate machinery while on opioids. This question is obviously critical in terms of whether opioid-treated patients should be encouraged to return to work, to normal daily activities and in particular, to driving. These studies find that cognitive function, manual dexterity and reaction times are maintained at normal levels provided a stable dose of opioid is used. This may not be true when dosing is irregular or escalates.
Function and Quality of Life
Many medical practitioners believe that improvements in function and quality of life are needed for long-term opioid treatment to be deemed a success, although a few believe that good pain relief, regardless of other markers of successful treatment, is enough to justify continued opioid treatment. Despite the importance of this debate, the literature provides surprisingly little evidence on nonanalgesia-related outcomes. Some randomized trials combine assessments of pain relief with assessment of function, but the focus of these assessments tends to vary with the primary interest of the investigators. While some investigators demonstrate improvements in limited measures of function, others find no difference ( Table 1 ). Observational trials contribute little in the way of assessment of function. Although some report improvement in broad measures such as ability to perform activities of daily living and return to work, others do not comment. Few opioid trials measure quality of life, which is again surprising given the importance of this factor and the fact that there are several validated measurement instruments available.
Several studies have looked specifically at cognitive function, including the ability to drive and operate machinery while on opioids. This question is obviously critical in terms of whether opioid-treated patients should be encouraged to return to work, to normal daily activities and in particular, to driving. These studies find that cognitive function, manual dexterity and reaction times are maintained at normal levels provided a stable dose of opioid is used. This may not be true when dosing is irregular or escalates.
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