There are many people with legitimate pain that need pain relief. BUT, there is a national crisis of opioid overdose deaths.  Healthcare providers can try to treat this pain with pain pills containing morphine, hydrocodone or oxycodone. The problem is that the data supporting long term pain medications is lacking. This study is interesting as the people on long term pain medication tolerated higher degrees of pain, but their quality of life was lacking. The exact reason for the correlation between long term pain medication prescriptions and lower quality of life is unknown. Nevertheless, it encourages patients and health care providers to seek non-opioid based treatments for chronic pain.

The Research

Effects of long-term opioid use in chronic low back pain patients: results from quantitative sensory testing and behavioral measures

Stanford University, Palo Alto, CA

Treatment of chronic low back pain (CLBP) with opioids is controversial given the high abuse liability and variable efficacy. To examine the effects of CLBP and opioid use on pain processing, we assessed heat pain thresholds (HPTr), cold pain tolerance (CPTol) measured by duration in a cold pressor test (CPT at 5ºC), and conditioned pain modulation (CPM) in which HPTr is assessed before and following CPT. We studied four groups: healthy controls (HC, n=36), CLBP on opioids (CLBP_O+, n=11), CLBP not on opioids (CLBP_O-, n=34) and methadone maintenance therapy (MM, n=30). Participants also completed a variety of questionnaires assessing demographics, mood, function and disability. Analyses revealed no significant group differences for HPTr before and following the CPT, or for CPM (ps > 0.05). However, CLBP_O+ patients had the highest CPTol among all groups (F_(3,107) = 3.18, p < 0.05). Interestingly, despite increased CPTol, CLBP_O+ showed more depression (Beck Depression Inventory) and disability (modified Oswestry Disability Index) compared to all groups except MMTP, which were also higher than CLBP_- and HC (ps < 0.05). Additionally, self-reported pain ratings or catastrophizing (Pain Catastrophizing scale) did not significantly differ between groups (ps > 0.05). Of most significance, we found that their despite increased CPTol, CLBP_O+ patients reported lower quality of life, comparable to MM patients, suggesting a strong relationship between long-term opioid use and low quality of life despite seemingly better sensory testing results.

Supported by Stanford University (Bio-X NeuroVentures), NIH K23DA031808, K23AT008477, P01AT006651, and K24DA029262.