Opioids Continue to Be Effective Long Term

Opioids Continue to Be Effective Long Term Medscape – Fran Lowry – October 01, 2013

This is a good review with results that ring true in my experience,

Unfortunately, it’s fatally tainted by funding from Purdue.

An extensive literature review of studies evaluating the effectiveness of long-term opioid therapy in chronic noncancer pain (CNCP) concludes that the drugs continue to provide reliable and safe analgesia for 6 months or more.

“Due to FDA regulatory guidelines, most contemporary phase 3 randomized controlled trials of opioid analgesics for CNCP are 3 months long or less.  

Also, doing placebo-controlled trials for longer than 3 months presents an ethical dilemma, because some patients have to go without analgesia, and also difficulties retaining patients,” Wallace said.

“There is great value in open-label studies, many of which are 6 months or more in duration and reflect actual patient experience before and after long-term opioid therapy,

in addition to those studies, we were able to look at RCTs [randomized controlled trials], open-label extension studies, and epidemiology studies, and in all of these, we see that improvements in pain scores are maintained,”

In this report, funded by Purdue Pharma, Wallace and her group searched for studies in MEDLINE, EMBASE, BIOSIS Previews, and PubMed through February 2013.

We all know that any link to Purdue, maker of Oxycontin, is toxic these days. I’m surprised that Purdue was still funding research in 2013.

By now we’ve learned that most research is tainted by the priorities of the funder (the boss), not the researchers (the workers). If they don’t find the results they want, they force the data through statistical contortions until the result supports the predetermined conclusions.

All literature evaluated the efficacy of opioids in CNCP when given for at least 6 months.

Forty-six studies had data for the percentage change in pain scores from baseline to end of study.

Of these,

  • 18 were 6 to less than 12 months in duration and
  • 28 were 12 months or longer in duration

Among studies 6 to less than 12 months long, 15 (83%) reported an improvement in pain of at least 25% from baseline.

Of the studies that lasted for 12 months or more, 223 (82%) reported an improvement in pain of greater than 25% from baseline.

Six RCTs, 14 open-label studies, and 8 open-label extension studies reported pain scores over 3-month intervals. All of these reported that pain decreased substantially from baseline to 3 months and that this decrease was maintained through 6 and 12 months. A few studies demonstrated a maintenance of pain scores out to 36 months.

“This is the first time that I’ve ever seen presented accumulated data that really speaks to the efficacy over a long period of time of using chronic opioids,” Dr. Hevern told Medscape Medical News.

“It is what people in the pain management group see, but we haven’t been able to effectively document it. This is the first time we’ve seen this efficacy documented in this manner,” he said.

This study was funded by Purdue Pharma. Ms. Wallace is an employee of Purdue Pharma. Dr. Hevern has disclosed no relevant financial relationships.

American Academy of Pain Management (AAPM) 24th Annual Clinical Meeting. Abstract #13. Presented September 27, 2013.

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