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Review
. 2017 Aug;26(8):1955-1967.
doi: 10.1007/s11136-017-1538-0. Epub 2017 Mar 2.

Health-related Quality of Life in Patients Receiving Long-Term Opioid Therapy: A Systematic Review With Meta-Analysis

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Free PMC article
Review

Health-related Quality of Life in Patients Receiving Long-Term Opioid Therapy: A Systematic Review With Meta-Analysis

J Douglas Thornton et al. Qual Life Res. .
Free PMC article

Abstract

Purpose: Over 25 million Americans reported having daily pain and between 5 and 8 million Americans used opioids to treat chronic pain in 2012. This is the first systematic review with meta-analysis to determine the effects of long-term opioid use on the Physical Component Summary (PCS) score and Mental Component Summary (MCS) scores of a Health-Related Quality of Life instrument in adults without opioid use disorder.

Methods: The a priori eligibility criteria for the PubMed (MEDLINE), Scopus, and PsyINFO searches were (1) randomized controlled trial, (2) at least one opioid intervention group, (3) minimum of 4-week duration of opioid use, (4) comparative control group, and (5) adults ≥18 years that do not have dominant disease. The unit of analysis was the standardized mean difference effect size (Hedges's g). All results were pooled using random-effects models.

Results: Of the 340 non-duplicate citations screened, 19 articles comprising 26 treatment comparisons and 6168 individuals (treatment n = 3160; comparators n = 3008 with duplicates removed) met the inclusion criteria for the systematic review. Thirteen treatment comparisons were available for the meta-analysis. Across all PCS analyses, small, statistically significant improvements were observed (opioid versus opioid only: g = 0.27, 95% CI 0.05-0.50, opioid versus placebo only: g = 0.18, 95% CI 0.08-0.28, and all studies combined: g = 0.22, 95% CI 0.11-0.32). There were small but not statistically significant changes on the MCS scores. Overall, high heterogeneity was present.

Conclusions: PCS scores improve with no change in MCS scores. However, long-term opioid trials are rare and only two trials included lasted longer than 1 year.

Keywords: Health-related quality of life; Meta-analysis; Opioid; Randomized controlled trials; Systematic review.

Figures

Fig. 1
Fig. 1
Flow diagram for the selection of studies. The primary reason for study exclusion is only listed once even though some could have been excluded for multiple reasons
Fig. 2
Fig. 2
Forest plot from the random-effects model for Physical Component Summary (PCS) scores for all eligible studies. OA1: Afilalo 2013 is one manuscript which presents HRQoL data from three RCTs with two comparators each. OA1 is the first osteoarthritis study, where OA1.1 is tapentadol versus placebo and OA1.2 is long-acting oxycodone versus placebo. OA2: Afilalo 2013 is one manuscript which presents HRQoL data from three RCTs with two comparators each. OA2 is the second osteoarthritis study, where OA2.1 is tapentadol versus placebo and OA2.2 is long-acting oxycodone versus placebo. LBP: Afilalo 2013 is one manuscript which presents HRQoL data from three RCTs with two comparators each. LBP is the lower back pain study, where LBP1 is tapentadol versus placebo and LBP2 is long-acting oxycodone versus placebo. ES effect size
Fig. 3
Fig. 3
Funnel plot for Physical Component Summary (PCS) random-effects model in all eligible studies
Fig. 4
Fig. 4
Forest plot from the random-effects model for Mental Component Summary (MCS) scores for all eligible studies. OA1: Afilalo 2013 is one manuscript which presents HRQoL data from three RCTs with two comparators each. OA1 is the first osteoarthritis study, where OA1.1 is tapentadol versus placebo and OA1.2 is long-acting oxycodone versus placebo. OA2: Afilalo 2013 is one manuscript which presents HRQoL data from three RCTs with two comparators each. OA2 is the second osteoarthritis study, where OA2.1 is tapentadol versus placebo and OA2.2 is long-acting oxycodone versus placebo. LBP: Afilalo 2013 is one manuscript which presents HRQoL data from three RCTs with two comparators each. LBP is the lower back pain study, where LBP1 is tapentadol versus placebo and LBP2 is long-acting oxycodone versus placebo. ES effect size
Fig. 5
Fig. 5
Funnel plot for Mental Component Summary (MCS) random-effects model for all eligible studies
Fig. 6
Fig. 6
Forest plot from the random-effects model for Physical Component Summary (PCS) scores (opioid versus placebo studies). OA1: Afilalo 2013 is one manuscript which presents HRQoL data from three RCTs with two comparators each. OA1 is the first osteoarthritis study, where OA1.1 is tapentadol versus placebo and OA1.2 is long-acting oxycodone versus placebo. OA2: Afilalo 2013 is one manuscript which presents HRQoL data from three RCTs with two comparators each. OA2 is the second osteoarthritis study, where OA2.1 is tapentadol versus placebo and OA2.2 is long-acting oxycodone versus placebo. LBP: Afilalo 2013 is one manuscript which presents HRQoL data from three RCTs with two comparators each. LBP is the lower back pain study, where LBP1 is tapentadol versus placebo and LBP2 is long-acting oxycodone versus placebo. ES effect size
Fig. 7
Fig. 7
Forest plot from the random-effects model for Mental Component Summary (MCS) scores (opioid versus placebo studies). OA1: Afilalo 2013 is one manuscript which presents HRQoL data from three RCTs with two comparators each. OA1 is the first osteoarthritis study, where OA1.1 is tapentadol versus placebo and OA1.2 is long-acting oxycodone versus placebo. OA2: Afilalo 2013 is one manuscript which presents HRQoL data from three RCTs with two comparators each. OA2 is the second osteoarthritis study, where OA2.1 is tapentadol versus placebo and OA2.2 is long-acting oxycodone versus placebo. LBP: Afilalo 2013 is one manuscript which presents HRQoL data from three RCTs with two comparators each. LBP is the lower back pain study, where LBP1 is tapentadol versus placebo and LBP2 is long-acting oxycodone versus placebo. ES effect size

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