Long‐term opioid therapy definitions and predictors: A systematic review

Abstract

Purpose This review sought to (a) describe definitions of long‐term opioid therapy (LTOT) outcome measures, and (b) identify the predictors associated with the transition from short‐term opioid use to LTOT for opioid‐naïve individuals. Methods We conducted a systematic review of the peer‐reviewed literature (January 2007 to July 2018). We included studies examining opioid use for more than 30 days. We classified operationalization of LTOT based on criteria used in the definitions. We extracted LTOT predictors from multivariate models in studies of opioid‐naïve individuals. Results The search retrieved 5,221 studies, and 34 studies were included. We extracted 41 unique variations of LTOT definitions. About 36% of definitions required a cumulative duration of opioid use of 3 months. Only 17% of definitions considered consecutive observation periods, 27% used days' supply, and no definitions considered dose. We extracted 76 unique predictors of LTOT from seven studies of opioid‐naïve patients. Common predictors included pre‐existing comorbidities (21.1%), non‐opioid prescription medication use (13.2%), substance use disorders (10.5%), and mental health disorders (10.5%). Conclusions Most LTOT definitions aligned with the chronic pain definition (pain more than 3 months), and used cumulative duration of opioid use as a criterion, although most did not account for consistent use. Definitions were varied and rarely accounted for prescription characteristics, such as days' supply. Predictors of LTOT were similar to known risk factors of opioid abuse, misuse, and overdose. As LTOT becomes a central component of quality improvement efforts, researchers should incorporate criteria to identify consistent opioid use to build the evidence for safe and appropriate use of prescription opioids.

Prevalence of Therapeutic use of Opioids in Chronic non-Cancer Pain Patients and Associated Factors: A Systematic Review and Meta-Analysis

“…A meta-analysis was performed if two or more studies reported the same characteristics in the information provided and the same measure of effect. In order to manage heterogeneity, the studies were first grouped according to the following aspects: the source of the sample (the general population or health registries/medical surveys); the duration of opioid treatment [long-term, commonly defined as more 3 months or short-term ( Karmali et al, 2020 )] and the type of pain ( Table 3 ).…”

“…This situation is of particular concern in patients with chronic non-cancer pain (CNCP), where the evidence of opioid therapy benefits may be less robust than that observed in patients with acute or cancer pain ( Von Korff et al, 2011 ; Scholten, 2013 ; Campbell et al, 2015 ). The duration of opioid therapy is also important with regard to the benefits for patients, since the prescription of opioids may be appropriate for short-term pain relief, but long-term opioid therapy (LTOT) cannot be associated with improvements in pain or function ( Karmali et al, 2020 ).…”

European* clinical practice recommendations on opioids for chronic noncancer pain – Part 1: Role of opioids in the management of chronic noncancer pain

“…Definitions of LTOT vary widely. Most studies define long-term as ≥12 weeks of opioid use (Karmali et al, 2020). Based on study duration of RCTs, we have made a classification for duration of opioid therapy for evidence-based recommendations for potential indication of opioids: short-term (4-12 weeks), intermediate-term (13-26 weeks), long-term (>26 weeks).…”

Inches, Centimeters, and Yards

“… 89 With opioid dose escalation, analgesic and unintended effects emerge asynchronously. While 90 MME may have cautionary mnemonic benefits in the midst of broad societal concern, a renewed emphasis on opioid tolerance and definitional harmonization (for daily MME and long-term therapy 11 , 90 ) seems overdue.…”