CHRONIC PAIN Opioids for chronic non-cancer pain doubled in quarter century The number of people with chronic non-cancer pain pre-scribed an opioid medicine worldwide increased in the last two-and-a-half decades. The researchers point to guidelines such as those from the Centres of Disease Control and Pre-vention in the United States that discourage the use of opioids to manage chronic non-cancer pain because of concerns about harmful effects and the lack of evidence about effec-tiveness. Chronic pain unrelated to cancer includes condi-tions such as chronic lower back pain, osteoarthritis and rheumatoid arthritis. The systematic review of studies from across the world is the first to examine the literature about the extent opioid pain relievers are being prescribed to manage people with chronic pain conditions. The research spanned eight countries and evaluated 42 published studies that included 5,059,098 people with chronic pain conditions (other than cancer) and aimed to establish a baseline for how commonly opioids are pre-scribed for people with non-cancer chronic pain conditions. In the early studies, opioid medicines were prescribed to about 20% of patients experiencing chronic pain but the later studies report rates of more than 40%. “Over this period, on average around 30% of people with chronic pain were prescribed an opioid medicine,” said lead author Dr. Stephanie Mathieson from the University of Syd-ney’s Institute for Musculoskeletal Health. “We noted that a higher proportion of people were prescribed a strong opioid medicine such as oxycodone compared to weak opioid pain-relieving medicines.” Between 1991 and 2015, the researchers found in people with chronic pain (unrelated to cancer): • Opioid prescribing increased over time from approximately 20% in early years to around 40% in later years. • On average over this period approximately one in three patients (30.7%) were prescribed an opioid medicine. • 42% of patients with chronic lower back pain were pre-scribed an opioid. • The average age of those prescribed an opioid medicine was 55.7 years. • Prescribing was not associated with the geographical loca-tion or the clinical setting where the opioids were prescribed (such as GPs or medical specialists). — UNIVERSITY OF SYDNEY www.canadianchiropractor.ca CC_Contemporary Medical_April20_CSA.indd 1 April 2020 Canadian Chiropractor 9 2020-02-25 1:09 PM
Chiropractic + Naturopathic Doctor April 2020: Page 9
