How Effective Are Opioids in Neuropathic Pain?
Improved function may not necessarily follow opioid treatment.
A new study suggests that opioid prescriptions for patients with neuropathic pain, may not improve their physical function or disability. In fact, results from the study — conducted by the University of Alberta and published in Pain Medicine — indicate that opioid use could be harmful when it comes to physical recovery for patients with neuropathic pain.
"We studied patients with neuropathic pain from nerve injuries such as diabetic neuropathy and pinched nerves, and the ones who weren't prescribed any opioids had statistically lower disability and higher physical functioning scores," said Geoff Bostick, PhD, lead author of the study.
The study sample included 789 patients with neuropathic pain across Canada. Patients gave self-reported measures of physical function (pain disability index) and a medical outcomes study short form-12 physical function (PCSS-12), at the beginning of the study, then again at 6 months and 12 months after treatment began. Analysis of covariance models was created to examine the association between opioid therapy and both physical functioning outcomes with adjustment for confounding.
Results showed that patients prescribed opioid treatment did not report greater physical functioning or lower disability than patients who were not prescribed opioids — even after the results were adjusted for disease severity. The improvements in disability and physical functioning scores from baseline and 12 months for all groups were "modest and may not be clinically significant," authors reported.
They asserted that while opioids are a powerful painkiller, the results of the study testify that improved function does not necessarily follow opioid treatment.
In addition, they highlighted the association between opioid prescription and a patient's quality of life, considering that the treatment may not be aiding the patient's functionality. They call for further research to analyze this correlation.
For those who have chronic pain but are medically cleared for physical activity, a graded approach to recovery is suggested, according to Dr. Bostick. "I tell patients to walk until they are at 50% of their tolerance — walk and stop before the pain gets too bad. Each week, walking time is gradually increased. Over time, this tolerance will slowly increase and so will physical function."