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Long-Term Opioid Therapy – What Are the Effects?
There have been a lot of questions in reference to long term use of opiods on this forum. This study answers all of those questions.
Long-Term Opioid Therapy – What Are the Effects?
Most people who need to take opioids on a long-term basis for chronic non-cancer pain are understandably concerned about what kind of effect it will have on them. Many have mistakenly believed that opioids destroy both the body and the brain – and possibly even shorten lives. Although pain management experts have long contended that opioid therapy is not dangerous when properly administered, until now there has been no actual research on long-term opioid use (10 years or more) to back them up.
Enter Forest Tennant, MD, who undertook a first-of-its-kind research study evaluating chronic pain patients who had been receiving opioid therapy for 10 to 35 years. The results of his study should be extremely encouraging for patients who need long-term opioid therapy as well as their doctors, some of whom may have been hesitant about it. Tennant concluded that the significant improvements in quality of life and physical functioning from opioid therapy are so positive they outweigh any negative complications, which can be easily managed.
Research Methods
Tennant's study looked at 16 female and 8 male chronic pain patients between 30 and 79 years of age. Their chronic pain conditions were:
Neuropathies and Arthropathies – 29.2%
Spinal Degeneration – 25%
Abdominal Adhesions or nNeuropathies – 20.8%
Fibromyalgia – 12.5%
Headache – 8.3%
Hip Necrosis –4.2%
The subjects had all been receiving continuous opioid therapy for 10 to 35 years. All were taking a long-acting form of morphine, oxycodone, fentanyl or methadone and one or more short-acting opioids for breakthrough pain or pain flares. They all also took additional medications such as muscle relaxants, sleep aids, hormone replacements and dietary supplements.
Study Results
Almost all of the patients (22 of 24) said their pain had permanently decreased over time. And the vast majority (20 of 24) felt their opioids still provided the same relief as when they started treatment. All of the patients reported one or more functions or activities they can do now that they couldn't do prior to beginning opioid therapy (i.e., get out of bed everyday, take walks, shop or visit friends).
Several new medical conditions developed in the group over the 10+ year period, such as hormone abnormalities, weight gain, tooth decay, tachycardia, hypertension, osteoporosis, hyperlipidemia, and diabetes. There was no clear way to determine whether these conditions were caused by the pain, the opioid therapy, the natural aging process, or were just inherent in the patients; however, all of the conditions could easily be medically managed.
All but one of the males in the study experienced lowered serum testosterone, a known complication of opioid therapy, which can be controlled by hormone replacement therapy.
Notably, there were no neurologic complications including dementia, hyperalgesia, tremor or seizures. Nor were there any liver, kidney, or gastrointestinal complications, except for minor constipation.
Conclusions
Rather than causing serious health problems, Tennant suggests that because of the decrease in pain, opioids may actually allow or even promote neurologic healing. He goes on to suppose that opioid therapy may prevent a number of medical complications of pain and also may prevent early death due to the over-stimulation of the pituitary-adrenal-axis or possibly electrical stimulation produced by damaged nerves. Tennant acknowledges that this is a small study and states that much additional study is needed to determine cause and effect of medical conditions in opioid-maintained patients.
Finally, Tennant concludes, “Even though the number of patients evaluated here is relatively small, the great improvement in their quality of life and physical functioning is so positive and the complications of the therapy so easily managed that long-term opioid therapy should continue to be provided and evaluated.”
Long-Term Opioid Therapy – What Are the Effects?
Most people who need to take opioids on a long-term basis for chronic non-cancer pain are understandably concerned about what kind of effect it will have on them. Many have mistakenly believed that opioids destroy both the body and the brain – and possibly even shorten lives. Although pain management experts have long contended that opioid therapy is not dangerous when properly administered, until now there has been no actual research on long-term opioid use (10 years or more) to back them up.
Enter Forest Tennant, MD, who undertook a first-of-its-kind research study evaluating chronic pain patients who had been receiving opioid therapy for 10 to 35 years. The results of his study should be extremely encouraging for patients who need long-term opioid therapy as well as their doctors, some of whom may have been hesitant about it. Tennant concluded that the significant improvements in quality of life and physical functioning from opioid therapy are so positive they outweigh any negative complications, which can be easily managed.
Research Methods
Tennant's study looked at 16 female and 8 male chronic pain patients between 30 and 79 years of age. Their chronic pain conditions were:
Neuropathies and Arthropathies – 29.2%
Spinal Degeneration – 25%
Abdominal Adhesions or nNeuropathies – 20.8%
Fibromyalgia – 12.5%
Headache – 8.3%
Hip Necrosis –4.2%
The subjects had all been receiving continuous opioid therapy for 10 to 35 years. All were taking a long-acting form of morphine, oxycodone, fentanyl or methadone and one or more short-acting opioids for breakthrough pain or pain flares. They all also took additional medications such as muscle relaxants, sleep aids, hormone replacements and dietary supplements.
Study Results
Almost all of the patients (22 of 24) said their pain had permanently decreased over time. And the vast majority (20 of 24) felt their opioids still provided the same relief as when they started treatment. All of the patients reported one or more functions or activities they can do now that they couldn't do prior to beginning opioid therapy (i.e., get out of bed everyday, take walks, shop or visit friends).
Several new medical conditions developed in the group over the 10+ year period, such as hormone abnormalities, weight gain, tooth decay, tachycardia, hypertension, osteoporosis, hyperlipidemia, and diabetes. There was no clear way to determine whether these conditions were caused by the pain, the opioid therapy, the natural aging process, or were just inherent in the patients; however, all of the conditions could easily be medically managed.
All but one of the males in the study experienced lowered serum testosterone, a known complication of opioid therapy, which can be controlled by hormone replacement therapy.
Notably, there were no neurologic complications including dementia, hyperalgesia, tremor or seizures. Nor were there any liver, kidney, or gastrointestinal complications, except for minor constipation.
Conclusions
Rather than causing serious health problems, Tennant suggests that because of the decrease in pain, opioids may actually allow or even promote neurologic healing. He goes on to suppose that opioid therapy may prevent a number of medical complications of pain and also may prevent early death due to the over-stimulation of the pituitary-adrenal-axis or possibly electrical stimulation produced by damaged nerves. Tennant acknowledges that this is a small study and states that much additional study is needed to determine cause and effect of medical conditions in opioid-maintained patients.
Finally, Tennant concludes, “Even though the number of patients evaluated here is relatively small, the great improvement in their quality of life and physical functioning is so positive and the complications of the therapy so easily managed that long-term opioid therapy should continue to be provided and evaluated.”
This is good news. However we all respond so differently and in addition to taking these meds long term, which I do and will be for severe pain we have to exercise, eat right, and add supplements. I have fibromyalgia and have had 7 surgeries on my spine. I have no collagen between my discs in my back. So I need the right nutrients through foods and supplements to aid in keeping my health as good as it can be. Smoking, drinking, eating a lot of simple sugars (high fructose) will make you sicker than some of the meds we take for pain. So while this study is a bit of good news we all need for a change look at the whole picture. The only exercise I can do is in the pool. Heated water either at the Y or at your local gym. Helps pain, keeps your heart in condition and can help you keep those pounds off. So keep this in mind, it's a whole body and mind approach. My very best to everyone. And thank you for this study. I will share it with my doctor.
great news...I too have my fears and this knowledge helps me deal better with the usage
thx Red
thx Red
The media hype is over people that are improperly using these medications for recreational use. When these selfish weak minded people do this they make it difficult for those of us that really need the medication to get it. It is a real shame.
Again thanks Red. I'll follow the link.
As you know we get this very question so many times on the PM Forum. It'll be a good source of reference for every one. I've never had the written proof to back up my beliefs on the benefits of long term opiate therapy. My prescribing physician has told me basically the contents of the article. However she is not published, nor involved in a certified study, or even a PMP so I couldn't use her as an authority.
There is so much media hype with the tragic results of opiate abuse. It out shadows any thing I could convey about the benefits...till now. So my hat is off to you......and your searching.
Gratefully,
Tuck
You came through for us once again.
As you know we get this very question so many times on the PM Forum. It'll be a good source of reference for every one. I've never had the written proof to back up my beliefs on the benefits of long term opiate therapy. My prescribing physician has told me basically the contents of the article. However she is not published, nor involved in a certified study, or even a PMP so I couldn't use her as an authority.
There is so much media hype with the tragic results of opiate abuse. It out shadows any thing I could convey about the benefits...till now. So my hat is off to you......and your searching.
Gratefully,
Tuck
You came through for us once again.
Thank you for this post, it answers some of my "fears". I have been taking opiods for just over a year now. They literally gave me my life back. Just recently though, I had many concerns about long time use, addiction etc. but did not want to even consider the quality of life I had (or lack there of), before this pain medication. I have searched various websites and could not find an actual study like this. Thanks again,
Lindy
Lindy
Here is a link with more information about Dr. Tennant. He has written many helpful articles in reference to studies on Pain Management.
http://www.paincare.org/about/board/tennant.html
http://www.paincare.org/about/board/tennant.html
I don't think that it is copyrighted. I found it posted on two different sites by different organizations.
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