We are sure that you are all aware that there is an argument used consistently that the long-term use of opioids has not been validated and remains in a sort of limbo. Even though there is ample anecdotal evidence that opioids do benefit a number of pain sufferers over many years this lack of evidence argument continues. But, now a recent article published in a European journal (Heroin Addict Relat. Clin. Problems), reports on the benefits of long-term use of opioids.

Dr. Forest Tennant, MD, reported on a group of patients who were administered strong opioids for from 10 to 35 years, with all indications that significant pain relief, ongoing quality of life and physical functioning enhancements outweigh any complications of this form of therapy. Any complication that rose were easily managed. The study involved 24 patients aged 30 to 79 years, two-thirds female and suffering from post trauma neuropathies and arthropathies (29%), spinal degeneration (25%), abdominal adhesions or neuropathies (20%), or fibromyalgia (12.5%). They had been on continuous opioid therapy for from 10 to 35 years, taking a long-acting formulation of either morphine, oxycodone, fentanyl, or methadone. One or more short-acting opioids were also prescribed for pain flares or breakthrough pain. The participants were also prescribed muscle relaxants, sleep aids, hormone replacement medications, and/or dietary supplements as were deemed as appropriate.

An overwhelming number (92%) reported their pain was permanently decreased, and the great majority (83%) believed the opioid regimen continued to relieve their pain as well as it did when treatment first began. All patients reported they could perform a variety of activities and physical functions that they could not do prior to opioid therapy. Hormonal abnormalities were a complication in the men, but was managed with hormone replacement therapy. Other complications reported included hypertension, diabetes, tooth decay and weight gain. They were all medically managed, but whether they were pain related, opioid produced, or simply inherent in the patients and/or a result of aging is unclear. No neurologic complications such as hyperalgesia, dementia, tremor, or seizures were note; nor were hepatic, renal, or gastrointestinal complications, except for minor constipation, which was also medically managed. 

Dr. Tennant concluded: “Even though the number of patients evaluated here is small, the great improvement in their quality of life and physical functioning is so positive and the complications of the therapy so easily managed that the long-term opioid therapy should continue to be provided and evaluated.”

Overall, the reported outcomes in this study offer hope for patients who might benefit from long-term opioid therapy for chronic noncancer pain. The study helps confirm the legitimization of pain as a chronic illness in certain patients and opioids as a justifiable long-term therapy. So much of the literature today speaks negatively of long-term use of opioid analgesic therapy and wrongly portrays patients who do well on them as potential drug seekers or abusers requiring intense surveillance. Such a perspective would be unheard of if they were using insulin or antihypertensives for chronic diseases like diabetes or hypertension.

Dt. Tenant acknowledges more studies are needed and is currently developing another study that would include more patients. There is presently another completed study, involving a large number of patients (3,000), showing many of the same results, being readied for publication. This validates much of the anecdotal information. § Source: Heroin Addict Related Clinical Problems.