Prevalence of Problematic Use of Opioids in Patients with Chronic Noncancer Pain: A Systematic Review with Meta‐analysis

Abstract

Background and Objective: Opioid prescription for chronic noncancer pain is associated with problematic use. We aimed to review and summarize the evidence on the prevalence of problematic use of opioids in adults with chronic noncancer pain and investigate whether the prevalence rates were changing over time. Databases and Data Treatment: A systematic review of the literature was undertaken following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. We systematically searched the literature in the electronic databases MEDLINE, SCOPUS, and Web of Science and studies with adult participants with chronic noncancer pain using opioids with indication of one or more of the following terms about problematic opioid use: abuse, misuse, addiction, dependence, problematic use, and aberrant behavior/use were eligible for data extraction. Meta-analysis was performed to estimate the pooled prevalence rates using a random-effects model, and subanalysis was conducted. Results: Our search identified a total of 784 potentially relevant studies. After a thorough evaluation, 19 papers, mostly from the United States, were included in our qualitative and quantitative synthesis. The majority of the data came from speciality pain clinics. The estimated prevalence of problematic use of opioids in adults with chronic noncancer pain was 36.3% (95% confidence interval: 27.4 to 45.2%; I 2 = 99.64%). Problematic opioid use was mostly identified using the questionnaire method. Thirteen studies (68%) presented a low risk of bias. Conclusions: Our study presents an alarming estimate regarding the prevalence of problematic use of opioids among patients with noncancer pain. These results deserve special attention from health care professionals and health authorities. &

Endogenous opioid systems alterations in pain and opioid use disorder

“…However, there remains a general consensus that high-quality research on this relationship is lacking ( Ballantyne, 2015 ; Voon et al, 2017 ; Nadeau et al, 2021 ). Nevertheless, qualitative evidence from clinical literature indicates that negative outcomes associated with opioid use can be instigated by pain severity ( Grol-Prokopczyk, 2017 ; Zajacova et al, 2021 ), duration of opioid use ( Chung et al, 2019 ; Jantarada et al, 2021 ), escalating opioid doses ( Zernig et al, 2007 ; Kaplovitch et al, 2015 ), comorbid anxiety and depression ( Peciña et al, 2018 ; Emery and Akil, 2020 ; Rogers et al, 2020 ), discontinuation of opioid medications ( Mark and Parish, 2019 ; Stein et al, 2021 ), and inherent risk factors like sex ( Manubay et al, 2015 ; McHugh, 2020 ) or genetics ( Kendler et al, 2003 ; Agarwal et al, 2017 ). Evidence from patients with pain and long-term opioid use have been critical in identifying potential risk factors for maladaptive opioid use but have yielded minimal impacts on either public health concern.…”

The Concept, Development, and Application of a Home-Based High-Definition tDCS for Bilateral Motor Cortex Modulation in Migraine and Pain

“…When widespread pain and headaches experiences become more severe and frequent, they tend to also be associated with multiple comorbidities that are detrimental to the patients' quality of life (e.g., emotional and social dysfunction). This worsens the risk for polypharmacy and medication overuse that iatrogenically can lead to serious adverse effects like opioid addiction ( 8 , 9 ). Hence, non-pharmacological pain therapies may not only be a safer option but also, most importantly, a practical pathway to scale back medication misuse in highly impacted pain patients.…”

Logic model for opioid analgesics in chronic non-malignant pain management, an in-depth qualitative methods study

“…Opioids are commonly used to manage CNMP [6] but some people may develop problematic opioid use which may increase the risk of opioid related morbidity and mortality. A recent systematic review (2021) reported that 36% (n= 55,647 patients) [7] people with CNMP used opioids unsafely, whereas a previous review (2015) highlighted 76% misuse of opioids by CNMP [8].…”