Systematic Review of the Quality and Generalizability of Studies on the Effects of Opioids on Driving and Cognitive/Psychomotor Performance

Mailis-Gagnon, Angela; Lakha, S. Fatima; Furlan, Andrea D.; Nicholson, Keith; Yegneswaran, Balaji; Sabatowski, Rainer

doi:10.1097/ajp.0b013e3182385332

Cited by 66 publications

(45 citation statements)

References 79 publications

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“…Fishbain reviewed studies that assessed psychomotor function and driving ability in opioid dependent patients and found strong evidence for no impairment of psychomotor function and driving ability [89]. CP patients on stable doses of opioids are considered safe to drive provided certain criteria are met: an absence of coprescriptions or other substances of abuse (alcohol or illicit drugs) with significant CNS effects, patients do not experience high levels of pain, an absence of a substantial sleep disorder or daytime somnolence and an absence of significant anxiety, depression or other psychiatric condition [90]. What is a stable opioid dose which is safe for driving is not known, and no study has compared driving performance and cognitive function in CP patients on opioids at low versus high doses.…”

Section: Opioids and Functional Outcomesmentioning

confidence: 99%

Chronic pain treatment with opioid analgesics: benefits versus harms of long-term therapy

Sehgal¹,

Colson²,

Smith³

2013

Expert Review of Neurotherapeutics

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Chronic non-cancer pain (CNCP) is a disabling chronic condition with a high prevalence rate around the world. Opioids are routinely prescribed for treatment of chronic pain (CP). In the past two decades there has been a massive increase in the number of opioid prescriptions, prescribed daily opioid doses and overall opioid availability. Many more patients with CNCP receive high doses of long-acting opioids on a long-term basis. Yet CP and related disability rates remain high, and majority of the patients with CNCP are dissatisfied with their treatments. Intersecting with the upward trajectory in opioid use are the increasing trends in opioid related adverse effects, especially prescription drug abuse, addiction and overdose deaths. This complex situation raises questions on the relevance of opioid therapy in the treatment of CNCP. This article reviews current evidence on opioid effectiveness, the benefits and harms of long-term therapy in CNCP.

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Section: Opioids and Functional Outcomesmentioning

confidence: 99%

Chronic pain treatment with opioid analgesics: benefits versus harms of long-term therapy

Sehgal¹,

Colson²,

Smith³

2013

Expert Review of Neurotherapeutics

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“…Only a few studies have examined the impact of chronic pain on complex psychomotor and cognitive tasks. According to a systematic review of the quality and generalizability of studies on the effects of opioids on driving and cognitive/psychomotor performance [24], high levels of pain may also affect aspects of these complex tasks. Moreover, it is important to note that cognitive impairment may occur in patients only when pain intensity levels exceed a certain threshold, which has been located between 64 and 71 of 100 [25].…”

Section: Introductionmentioning

confidence: 99%

Assessing Cognitive and Psychomotor Performance in Patients with Fibromyalgia Syndrome

Shmygalev

Dagtekin²,

Gerbershagen

et al. 2014

Pain Ther

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IntroductionPatients with fibromyalgia syndrome (FMS) generally present with chronic widespread pain, accompanied by a range of additional and non-specific symptoms, such as fatigue, disturbed sleep, and cognitive dysfunction, which tend to increase with overall severity. Previous studies have shown moderate cognitive impairment in patients with FMS, but there are few valid data explicitly assessing the relevance of these findings to everyday functions, such as driving ability. Therefore, we studied patients with FMS to assess the impact of FMS on tests that predict driving ability.MethodsFemale patients with FMS were prospectively compared to a historical control group of healthy volunteers. The test battery comprised assessments of visual orientation, concentration, attention, vigilance, motor coordination, performance under stress, and reaction time.ResultsA total of 43 patients were matched to 129 controls. The results indicated that the patients’ psychomotor and cognitive performances were significantly non-inferior when compared to healthy controls (with 0.05% alcohol), with the exception of motor coordination. Patients and healthy controls showed an age-related decline in test performance. Correlations were smaller in patients and reversed for vigilance which was linked to a greater FMS symptom load in younger patients.ConclusionThe results of the present study demonstrate that, in general, the driving ability of patients with FMS was not inferior to that of healthy volunteers based on a standardized computer-based test battery. However, variables, such as younger age, depression, anxiety, fatigue, pain, and poor motor coordination, likely contribute to the subjective perception of cognitive dysfunction in FMS.Electronic supplementary materialThe online version of this article (doi:10.1007/s40122-014-0028-0) contains supplementary material, which is available to authorized users.

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“…[5][6][7] Although the potential effects of opioids on driving ability are of particular concern given their increasing use and misuse, major gaps persist in understanding the impact of opioid dose, concomitant medication use, and opioid formulation. 8 Opioid-related drug overdoses are becoming increasingly prevalent, amounting to more than 40% of deaths due to drug overdoses in the United States. 1 Opioids can interfere with attention and impair reaction time, 9,10 leading to concerns regarding impaired driving performance.…”

mentioning

confidence: 99%

Opioid Dose and Risk of Road Trauma in Canada

Gomes¹,

Redelmeier²,

Juurlink³

et al. 2013

JAMA Intern Med

134

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Systematic Review of the Quality and Generalizability of Studies on the Effects of Opioids on Driving and Cognitive/Psychomotor Performance

Abstract: The commonly held concept that "chronic pain patients on stable opioids are safe to drive" cannot be generalized to all such patients in everyday practice, but may be applicable only to a subset who meet certain criteria.

Cited by 66 publications

References 79 publications

Chronic pain treatment with opioid analgesics: benefits versus harms of long-term therapy

Chronic pain treatment with opioid analgesics: benefits versus harms of long-term therapy

Assessing Cognitive and Psychomotor Performance in Patients with Fibromyalgia Syndrome

Opioid Dose and Risk of Road Trauma in Canada

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