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Long Term Opiate Therapy

Dec 03, 2009 - 7 comments

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.”


Comments
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by katgood, Jul 09, 2011
AMEN!!!!!

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by Tuckamore, Jul 09, 2011
I so agree! It's not often you find something positive or encouraging.for we Chronic Pain ppl. I second your AMEN!!

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by aheart, Jul 09, 2011
Thanks for that, they say that pain is the fifth vital sign. Pain control is responsible for our quality of life, and without that for many life would not be worth living. For that reason I hope the feds coming down hard on doctors for pain control, don't
hurt the people who need it the most!  Include me in that amen.

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by Weffette, Jul 10, 2011
The operative words here:  QUALITY OF LIFE
Opiates work with the central nervous system and thats why they work so well on chronic pain. A twisted ankle, a strained muscle...non opiates work fine...for nerve damage pain, joint pain, etc....opiates are the answer.   Try to get your doctor to prescribe opiates for you, let me know how successful you are.  Might as well smoke pot...its probably easier to get!  
I'm not trying to be sarcastic...its just ridiculous how doctors are so reluctant to accept a patients complaints of chronic pain. "Can't see it...must not be there" attitude. There are doctors out there that don't believe in Fibromyalgia!  But...many people who complain of aches and pains are automatically diagnosed with it, as an "umbrella" ailment by doctors that don't understand Fibro.  
Bingo aheart.!  ;)
I wish I had gone to medical school !!

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by Tuckamore, Jul 15, 2011
The DEA,  Abusers and Addicts can be blamed for the mess we Chronic Pain sufferers find ourselves. Uneducated physicians in Chronic Pain are fearful of losing their licenses and have trouble distinguishing between true Chronic Pain (CP) patients and Drug Seekers.

True Drug Seekers/Addicts are great con artists and often know all the right words to say .... CP patients aren't usually eloquent in word.... to put it mildly we just HURT!

Waffette you can feel free to be sarcastic.... it maddening when ppl that have true pain are not able to find adequate pain control due in a large part to the uneducated society and opiate phobics that abound. Even if you find adequate pain control many friends and family, even some medical professionals classify you with the Drug Seekers and Addicts. Suddenly we're weak as if we just have a hang nail and want to get "High!"  

I'm Blessed! I found an astute, kind and caring PCP that recognized my pain, found a diagnosis and treated my pain. Now my condition is so obvious that I have not had an issue.... but even we that are receiving pain management live in near daily fear that that could change at any moment.

Negative effects of Long Term Opiate Therapy is the least of my concerns.... I believe in Quality of Life!!

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by shinty, Apr 18, 2013
well said Tuck.

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by philnoir, Jun 13, 2015
Dr. Tennant is a true pain warrior. His website, http://www.practicalpainmanagement.com/, is a vital resource of information for pain practitioners and other medical professionals, as well as those of us who live with chronic intractable pain.

Dr. Tennant is well into his 70s now, after a 40+ year career of researching and treating pain. He rarely consults with new patients, but does have specific interests in those who suffer from central pain syndromes. If you are at a loss for treatment options in a diagnosed central pain syndrome, contact Dr. Tennant through the website. If you have the resources to see him in his southern California office (home) once a month, and your doctor will cooperate, he may find off-label, unconventional medical treatments that can help.

But you must be able to see him regularly and realize that he will not treat you, only consult.

Better is to read his journal and find your own answers. This requires a lot of self-education, but if you, like me, live with chronic pain, what else are you going to do with your time? There's nothing on TV, and I imagine the singles bars around your house are like those here -- the regulars have been to too way many rodeos.

So why not put in some time every day and study your disease, its etiology and progression (etiology -- good medical word to know), and treatment options. While you're at it, learn how doctors think (when they do think -- once they knew how to think), medical terminology, everything you can about your diagnosis (Dx), prognosis (Px), and treatment options (Tx). With treatment options, learn the risks as well as the benefits. Often, its more important to understand risk than benefit, especially when considering surgical treatments.

That's enough lecturing for one post. It's your disease, it's your pain, and the medical choices are also yours to make. But you need knowledge to work with your doctor to make the best decisions. Get with it.

-- Doc Black

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