Introduction
In the realm of chronic non-cancer pain (CNCP) management, the choice between long-term opioid therapy (LTOT) and non-opioid analgesics is critical. A recent study titled "All-cause mortality in patients with long-term opioid therapy compared with non-opioid analgesics for chronic non-cancer pain: a database study" sheds light on the mortality risks associated with these treatments. Understanding these risks can guide practitioners in making informed decisions, ultimately improving patient outcomes.
Key Findings from the Study
The study utilized the InGef database, analyzing data from over 4.7 million insured individuals in Germany between 2013 and 2017. It compared the all-cause mortality rates of patients on LTOT with those using non-opioid analgesics such as anticonvulsants, antidepressants, dipyrone, and NSAIDs.
Results showed that patients on LTOT had a 1.59 times higher risk of all-cause mortality compared to those on non-opioid therapies. Specifically, LTOT was associated with 148 excess deaths per 10,000 person-years. Notably, the increased risk was primarily linked to out-of-hospital deaths, with an adjusted hazard ratio (HR) of 2.29.
Implications for Practitioners
For practitioners, these findings underscore the importance of carefully considering the risks associated with opioid prescriptions for CNCP. Here are some practical steps to enhance decision-making:
- Shared Decision-Making: Engage patients in discussions about the potential risks and benefits of opioid versus non-opioid therapies. This approach empowers patients to make informed choices.
- Risk Assessment: Evaluate each patient's risk factors, including age, comorbidities, and previous medication history, to tailor treatment plans accordingly.
- Monitoring and Follow-Up: Regularly monitor patients on LTOT for signs of adverse effects, and adjust treatment plans as necessary to mitigate risks.
- Consider Alternatives: Explore non-opioid analgesics and non-pharmacological interventions as viable alternatives for managing CNCP.
Encouraging Further Research
While this study provides valuable insights, it also highlights the need for further research to refine our understanding of opioid and non-opioid therapies. Practitioners are encouraged to contribute to and stay informed about ongoing research efforts in this area.
Conclusion
The study's findings emphasize the critical need for data-driven decisions in managing CNCP. By considering the risks associated with LTOT and exploring alternative therapies, practitioners can enhance patient outcomes and reduce mortality risks.
To read the original research paper, please follow this link: All-cause mortality in patients with long-term opioid therapy compared with non-opioid analgesics for chronic non-cancer pain: a database study.
