Opioids Have Little Effect on Cognition

The Effects of Opioids on Cognition in Older Adults With Cancer and Chronic Noncancer Pain: A Systematic ReviewOct 2019

I’m only able to access the abstract here, but it says pretty much what pain patients already know: unless we’re also taking other non-opioid medications, like Gabapentin or antidepressants, there is “no effect of opioid use on cognitive domains”.

Context

Opioids are prescribed to manage moderate-to-severe pain and can be used with older adults; however, they may lead to several adverse effects, including cognitive impairment.

This is purely conjecture since it has NOT been proven.  

Yet, this conclusion is stated in the “Context” of a study investigating exactly what they are stating as fact, but which the study itself finds to be untrue. This is not science, it’s wishful thinking and opioid-bashing.

Objectives

To identify, appraise, and synthesize evidence on the impact of opioids on cognition in older adults with cancer/chronic noncancer pain, and screening tools/neuropsychological assessments used to detect opioid-induced cognitive impairment.

Methods

A systematic literature review following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane Library, and Web of Science were searched up to December 2018.

Randomized controlled trials, quasi-experimental studies, and observational studies of adults aged 65 years and older with cancer/chronic noncancer pain taking opioids were included. A narrative synthesis was conducted.

Results

From 4036 records, 10 met inclusion criteria. Five studies used one screening tool, and five studies used a range of neuropsychological assessments; assessing 14 cognitive domains.

Most studies demonstrated no effect of opioid use on cognitive domains, whereas four studies showed mixed effects.

In particular, attention, language, orientation, psychomotor function, and verbal working/delayed episodic memory were worsened.

Changes to cognitive function were predominantly observed in studies with higher mean doses of opioids (120–190.7mg oral morphine equivalent daily dose).

Conclusion

Both improvements and impairments to cognition were observed in studies with higher mean opioid doses.

In clinical practice, a brief screening tool assessing

  • attention,
  • language,
  • orientation,
  • psychomotor function, and
  • verbal working/delayed episodic memory

may be beneficial to detect worsening cognition in older adults with chronic pain using opioids.

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