Association of long-term opioid therapy with functional status, adverse outcomes, and mortality among patients with polyneuropathy

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Abstract

IMPORTANCE: Polyneuropathy is one of the most common painful conditions managed within general and specialty clinics. Neuropathic pain frequently leads to decisions about using long-term opioid therapy. Understanding the association of long-term opioid use with functional status, adverse outcomes, and mortality among patients with polyneuropathy could influence disease-specific decisions about opioid treatment. OBJECTIVES: To quantify the prevalence of long-term opioid use among patients with polyneuropathy and to assess the association of long-term opioid use with functional status, adverse outcomes, and mortality. DESIGN, SETTING, AND PARTICIPANTS: A retrospective population-based cohort studywas conducted of prescriptions given to patients with polyneuropathy and to controls in ambulatory practice between January 1, 2006, and December 31, 2010, to determine exposure to long-term opioid use as well as other outcomes. The latest follow-up was conducted through November 25, 2016. EXPOSURES: Long-term opioid therapy, defined by 1 or multiple consecutive opioid prescriptions resulting in 90 continuous days or more of opioid use. MAIN OUTCOMES AND MEASURES: Prevalence of long-term opioid therapy among patients with polyneuropathy and controls. Patient-reported functional status, documented adverse outcomes, and mortality were compared between patients with polyneuropathy receiving long-term opioid therapy (≥90 days) and patients with polyneuropathy receiving shorter durations of opioid therapy. RESULTS: Among the 2892 patients with polyneuropathy (1364 women and 1528 men; mean [SD] age, 67.5 [16.6] years) and the 14 435 controls (6827 women and 7608 men; mean [SD] age, 67.5 [16.5] years), patients with polyneuropathy received long-term opioids more often than did controls (545 [18.8%] vs 780 [5.4%]). Patients with polyneuropathy who were receiving long-term opioids had multiple functional status markers that were modestly poorer even after adjusting for medical comorbidity, including increased reliance on gait AIDS (adjusted odds ratio, 1.9; 95%CI, 1.4-2.6); no functional status markers were improved by long-term use of opioids. Adverse outcomes were more common among patients with polyneuropathy receiving long-term opioids, including depression (adjusted hazard ratio, 1.53; 95%CI, 1.29-1.82), opioid dependence (adjusted hazard ratio, 2.85; 95%CI, 1.54-5.47), and opioid overdose (adjusted hazard ratio, 5.12; 95%CI, 1.63-19.62). CONCLUSIONS AND RELEVANCE: Polyneuropathy increased the likelihood of long-term opioid therapy. Chronic pain itself cannot be ruled out as a source of worsened functional status among patients receiving long-term opioid therapy. However, long-term opioid therapy did not improve functional status but rather was associated with a higher risk of subsequent opioid dependency and overdose.

Original languageEnglish (US)
Pages (from-to)773-779
Number of pages7
JournalJAMA Neurology
Volume74
Issue number7
DOIs
StatePublished - Jul 1 2017

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Polyneuropathies
Opioid Analgesics
Mortality
Therapeutics
Prescriptions

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

@article{01f34d33f0e4410d9531fdbc2f54cbf4,
title = "Association of long-term opioid therapy with functional status, adverse outcomes, and mortality among patients with polyneuropathy",
abstract = "IMPORTANCE: Polyneuropathy is one of the most common painful conditions managed within general and specialty clinics. Neuropathic pain frequently leads to decisions about using long-term opioid therapy. Understanding the association of long-term opioid use with functional status, adverse outcomes, and mortality among patients with polyneuropathy could influence disease-specific decisions about opioid treatment. OBJECTIVES: To quantify the prevalence of long-term opioid use among patients with polyneuropathy and to assess the association of long-term opioid use with functional status, adverse outcomes, and mortality. DESIGN, SETTING, AND PARTICIPANTS: A retrospective population-based cohort studywas conducted of prescriptions given to patients with polyneuropathy and to controls in ambulatory practice between January 1, 2006, and December 31, 2010, to determine exposure to long-term opioid use as well as other outcomes. The latest follow-up was conducted through November 25, 2016. EXPOSURES: Long-term opioid therapy, defined by 1 or multiple consecutive opioid prescriptions resulting in 90 continuous days or more of opioid use. MAIN OUTCOMES AND MEASURES: Prevalence of long-term opioid therapy among patients with polyneuropathy and controls. Patient-reported functional status, documented adverse outcomes, and mortality were compared between patients with polyneuropathy receiving long-term opioid therapy (≥90 days) and patients with polyneuropathy receiving shorter durations of opioid therapy. RESULTS: Among the 2892 patients with polyneuropathy (1364 women and 1528 men; mean [SD] age, 67.5 [16.6] years) and the 14 435 controls (6827 women and 7608 men; mean [SD] age, 67.5 [16.5] years), patients with polyneuropathy received long-term opioids more often than did controls (545 [18.8{\%}] vs 780 [5.4{\%}]). Patients with polyneuropathy who were receiving long-term opioids had multiple functional status markers that were modestly poorer even after adjusting for medical comorbidity, including increased reliance on gait AIDS (adjusted odds ratio, 1.9; 95{\%}CI, 1.4-2.6); no functional status markers were improved by long-term use of opioids. Adverse outcomes were more common among patients with polyneuropathy receiving long-term opioids, including depression (adjusted hazard ratio, 1.53; 95{\%}CI, 1.29-1.82), opioid dependence (adjusted hazard ratio, 2.85; 95{\%}CI, 1.54-5.47), and opioid overdose (adjusted hazard ratio, 5.12; 95{\%}CI, 1.63-19.62). CONCLUSIONS AND RELEVANCE: Polyneuropathy increased the likelihood of long-term opioid therapy. Chronic pain itself cannot be ruled out as a source of worsened functional status among patients receiving long-term opioid therapy. However, long-term opioid therapy did not improve functional status but rather was associated with a higher risk of subsequent opioid dependency and overdose.",
author = "Hoffman, {E. Matthew} and James Watson and {St. Sauver}, Jennifer and Staff, {Nathan P} and Klein, {Christopher Jon}",
year = "2017",
month = "7",
day = "1",
doi = "10.1001/jamaneurol.2017.0486",
language = "English (US)",
volume = "74",
pages = "773--779",
journal = "JAMA Neurology",
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TY - JOUR

T1 - Association of long-term opioid therapy with functional status, adverse outcomes, and mortality among patients with polyneuropathy

AU - Hoffman, E. Matthew

AU - Watson, James

AU - St. Sauver, Jennifer

AU - Staff, Nathan P

AU - Klein, Christopher Jon

PY - 2017/7/1

Y1 - 2017/7/1

N2 - IMPORTANCE: Polyneuropathy is one of the most common painful conditions managed within general and specialty clinics. Neuropathic pain frequently leads to decisions about using long-term opioid therapy. Understanding the association of long-term opioid use with functional status, adverse outcomes, and mortality among patients with polyneuropathy could influence disease-specific decisions about opioid treatment. OBJECTIVES: To quantify the prevalence of long-term opioid use among patients with polyneuropathy and to assess the association of long-term opioid use with functional status, adverse outcomes, and mortality. DESIGN, SETTING, AND PARTICIPANTS: A retrospective population-based cohort studywas conducted of prescriptions given to patients with polyneuropathy and to controls in ambulatory practice between January 1, 2006, and December 31, 2010, to determine exposure to long-term opioid use as well as other outcomes. The latest follow-up was conducted through November 25, 2016. EXPOSURES: Long-term opioid therapy, defined by 1 or multiple consecutive opioid prescriptions resulting in 90 continuous days or more of opioid use. MAIN OUTCOMES AND MEASURES: Prevalence of long-term opioid therapy among patients with polyneuropathy and controls. Patient-reported functional status, documented adverse outcomes, and mortality were compared between patients with polyneuropathy receiving long-term opioid therapy (≥90 days) and patients with polyneuropathy receiving shorter durations of opioid therapy. RESULTS: Among the 2892 patients with polyneuropathy (1364 women and 1528 men; mean [SD] age, 67.5 [16.6] years) and the 14 435 controls (6827 women and 7608 men; mean [SD] age, 67.5 [16.5] years), patients with polyneuropathy received long-term opioids more often than did controls (545 [18.8%] vs 780 [5.4%]). Patients with polyneuropathy who were receiving long-term opioids had multiple functional status markers that were modestly poorer even after adjusting for medical comorbidity, including increased reliance on gait AIDS (adjusted odds ratio, 1.9; 95%CI, 1.4-2.6); no functional status markers were improved by long-term use of opioids. Adverse outcomes were more common among patients with polyneuropathy receiving long-term opioids, including depression (adjusted hazard ratio, 1.53; 95%CI, 1.29-1.82), opioid dependence (adjusted hazard ratio, 2.85; 95%CI, 1.54-5.47), and opioid overdose (adjusted hazard ratio, 5.12; 95%CI, 1.63-19.62). CONCLUSIONS AND RELEVANCE: Polyneuropathy increased the likelihood of long-term opioid therapy. Chronic pain itself cannot be ruled out as a source of worsened functional status among patients receiving long-term opioid therapy. However, long-term opioid therapy did not improve functional status but rather was associated with a higher risk of subsequent opioid dependency and overdose.

AB - IMPORTANCE: Polyneuropathy is one of the most common painful conditions managed within general and specialty clinics. Neuropathic pain frequently leads to decisions about using long-term opioid therapy. Understanding the association of long-term opioid use with functional status, adverse outcomes, and mortality among patients with polyneuropathy could influence disease-specific decisions about opioid treatment. OBJECTIVES: To quantify the prevalence of long-term opioid use among patients with polyneuropathy and to assess the association of long-term opioid use with functional status, adverse outcomes, and mortality. DESIGN, SETTING, AND PARTICIPANTS: A retrospective population-based cohort studywas conducted of prescriptions given to patients with polyneuropathy and to controls in ambulatory practice between January 1, 2006, and December 31, 2010, to determine exposure to long-term opioid use as well as other outcomes. The latest follow-up was conducted through November 25, 2016. EXPOSURES: Long-term opioid therapy, defined by 1 or multiple consecutive opioid prescriptions resulting in 90 continuous days or more of opioid use. MAIN OUTCOMES AND MEASURES: Prevalence of long-term opioid therapy among patients with polyneuropathy and controls. Patient-reported functional status, documented adverse outcomes, and mortality were compared between patients with polyneuropathy receiving long-term opioid therapy (≥90 days) and patients with polyneuropathy receiving shorter durations of opioid therapy. RESULTS: Among the 2892 patients with polyneuropathy (1364 women and 1528 men; mean [SD] age, 67.5 [16.6] years) and the 14 435 controls (6827 women and 7608 men; mean [SD] age, 67.5 [16.5] years), patients with polyneuropathy received long-term opioids more often than did controls (545 [18.8%] vs 780 [5.4%]). Patients with polyneuropathy who were receiving long-term opioids had multiple functional status markers that were modestly poorer even after adjusting for medical comorbidity, including increased reliance on gait AIDS (adjusted odds ratio, 1.9; 95%CI, 1.4-2.6); no functional status markers were improved by long-term use of opioids. Adverse outcomes were more common among patients with polyneuropathy receiving long-term opioids, including depression (adjusted hazard ratio, 1.53; 95%CI, 1.29-1.82), opioid dependence (adjusted hazard ratio, 2.85; 95%CI, 1.54-5.47), and opioid overdose (adjusted hazard ratio, 5.12; 95%CI, 1.63-19.62). CONCLUSIONS AND RELEVANCE: Polyneuropathy increased the likelihood of long-term opioid therapy. Chronic pain itself cannot be ruled out as a source of worsened functional status among patients receiving long-term opioid therapy. However, long-term opioid therapy did not improve functional status but rather was associated with a higher risk of subsequent opioid dependency and overdose.

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