Does Long-Term Opioid Therapy Reduce Pain Sensitivity of Patients with Chronic Low Back Pain? Evidence from Quantitative Sensory Testing

Abstract

Background: Long-term opioid treatment has been used extensively in treatment of chronic low back pain (cLBP) in the last decades. However, there are serious limitations to the long-term efficacy of opioids and related side effects. Objectives: In this study we investigated whether long-term opioid treatment changes pain sensitivity of patients with cLBP. Study Design: A prospective, nonrandomized, cross-sectional study. Setting: Multidisciplinary pain management clinic, specialty referral center, university hospital in Germany. Methods: Using quantitative sensory testing (QST), we compared the pain sensitivity of the low back bilaterally among 3 groups: 35 patients with cLBP undergoing a long-term opioid therapy (OP); 35 patients with cLBP administered no opioids (ON), and 28 subjects with neither pain nor opioid intake (HC). Results: OP patients showed significantly higher bilateral thermal detection thresholds to warm stimuli on the back as compared to both ON (P = 0.009 for left low back, P = 0.008 for right low back) and HC subjects (P = 0.004 for left low back, P = 0.003 for right low back). Pain thresholds for cold and heat on the hand were similar in OP and ON groups; both showed, however, significantly reduced heat pain thresholds in comparison with HC participants (P = 0.012 for OP, P = 0.001 for ON). Factors such as age, sex, duration and dose of opioid intake, and self-reported pain intensity, but not depression and pain duration, correlated significantly with QST results. Limitations: Limitations include small numbers of patients with heterogeneous opioid therapy and the nonrandomized observational nature of the study. Conclusions: The current study demonstrated that chronic opioid intake may only reduce the temperature sensitivity but not pain sensitivity measured by QST which is a useful tool in detecting characteristic changes in pain perception of patients with chronic low back pain after long-term opioid intake. Key words: Pain sensitivity, opioid treatment, chronic low back pain (cLBP), quantitative sensory testing (QST)

Does preoperative opioid therapy in patients with a single lumbar disc herniation positively influence the postoperative outcome detected by quantitative sensory testing?

“…In our cohort, no differences were found in mechanical or thermal thresholds at any time. This differs from results of previous clinical trials and might be explained by different factors [ 2 , 48 , 49 ]. Sample sizes, as well as patient groups (e.g.…”

“…Moreover, it is well examined that heat and pressure pain thresholds tend to be lower in women and that elderly patients tend to be less sensitive. Also, this may lead to different reference values [ 35 , 48 ]. Further factors leading to diverging results might be the heterogeneity of opioid medication, as well as the duration and dose of opioid intake, in studies investigating the influence of these drugs.…”

Mediating Effect of Pain Sensitization on the Paradoxical Relation of Taking Opioids to Pain Severity in Knee Osteoarthritis: The Multicenter Osteoarthritis Study

“…16 A few crosssectional studies demonstrated that taking opioid was associated with pain sensitivity measured by QST and pain severity in individuals with chronic spinal pain 17 and chronic noncancer pain. 18,19 Whether pain sensitization mediates the development of OIH (ie, increased pain due to taking opioids) in knee OA is not known. Such insights would be helpful to guide whether measures of pain sensitization may be useful as means to gauge development of OIH.…”

“…Two studies demonstrated an increase in heat or cold pain sensitivity after one month of taking opioid in individuals with chronic low back pain 15 and neuropathic radicular pain 16 . A few cross‐sectional studies demonstrated that taking opioid was associated with pain sensitivity measured by QST and pain severity in individuals with chronic spinal pain 17 and chronic noncancer pain 18,19 …”

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“…Seminowicz et al, 2011;Tesarz et al, 2015;Ung et al, 2014;Vachon-Presseau et al, 2013;Vuilleumier et al, 2017;Wang et al, 2012;Wasan et al, 2011;Yang et al, 2017;Yu et al, 2014). Nineteen(Apkarian et al, 2004;Barke et al, 2012;Buckalew et al, 2008;Carragee et al, 2000;Frymoyer et al, 1984Frymoyer et al, , 1985Kong et al, 2013;Kornelsen et al, 2013;Mansour et al, 2017;Mao et al, 2013;Meier et al, 2016;Muhtz et al, 2013;O'Neill et al, 2014;Puta et al, 2012;Rodriguez-Raecke et al, 2014;Ung et al, 2014;Wang et al, 2012;Yang et al, 2017;Yu et al, 2014) could not be included in quantitative analyses as the required data were not presented and/or the authors did not respond despite a minimum of three contact attempts. Subsequently, 33 studies were available for quantitative synthesis(Boos et al, 1995;Burns, 2006;D'Hooge et al, 2013;Derbyshire et al, 2002;Diers et al, 2007;Dolman et al, 2014;Dubois et al, 2016;Franz et al, 2014;Gerhardt et al, 2016;Giesecke et al, 2004;…”