A Systematic Review and Meta-Analysis of Cognitive Performance among People with Chronic Use of Opioids for Chronic Non-Cancer Pain

Opioid Therapy in Chronic Pain: Assessment of Clinical Outcomes and Relationships With Endocrine Biomarkers

BACKGROUND

Long-term opioid treatment (L-TOT) may have consequences that are mediated by factors affecting functionality and health-related quality of life. This study aimed at investigating associations between L-TOT and clinical outcomes including sustained attention, short-term and working memory, worst pain intensity, sleep quality, mood, and health-related quality of life in patients with chronic non-cancer pain (CNCP). Additionally, the study aimed at exploring whether endocrine biomarkers mediate the relationship between L-TOT and these outcomes.

METHODS

Cross-sectional study with 82 adult CNCP patients divided into two groups (opioid treated (n = 38) and controls not treated with opioids (n = 44)). Linear regression analyses assessed associations between L-TOT, outcome variables, and the mediating effects of endocrine biomarkers. A Bootstrap approach with 95% confidence intervals was applied to analyse the natural indirect effect.

RESULTS

The opioid group had worse sleep quality (p = 0.018), physical functioning (p = 0.0186), social functioning (p = 0.002), and higher pain intensity (p < 0.001) compared with controls. Men in the L-TOT group experienced worse measures for the same variables, and additionally for anxiety (p = 0.028), depression (p = 0.040), role physical (p = 0.038), role emotional (p < 0.001), fatigue (p = 0.019), and emotional well-being (p = 0.001). Only the association between L-TOT and anxiety in men was significantly mediated by total testosterone (β = 1.6, Bias-Corrected Bootstrap 95% CI: 0.1; 4.1, p = 0.045).

CONCLUSIONS

CNCP patients in L-TOT showed significantly poorer outcomes than controls. Only testosterone mediated anxiety in men, indicating a natural indirect effect. Causality and mediating effects of endocrine biomarkers need to be further explored, but the associations are an alert to the potential effects of opioids.

SIGNIFICANCE STATEMENT

This study reveals the broader health impacts of opioid use, particularly the role of hormone-related factors in men, which may be linked to specific adverse effects and consequences. Investigating these hormonal dynamics could lead to improved treatment strategies and outcomes.

Perceived cognitive functioning difficulties in individuals living with endometriosis

Difficulties in cognitive functioning (e.g., memory, attention) are common in chronic conditions characterized by physical pain, fatigue and depression. Yet investigations in endometriosis are lacking. We aimed to assess: (1) perceived cognitive functioning, (2) the association of cognitive functioning with fatigue, pain and depressive symptoms, and (3) whether endometriosis treatments moderated these relationships. Participants (n = 1239) with diagnosed endometriosis completed an online survey assessing perceived cognitive functioning [Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog)], pain, fatigue and depression. FACT-Cog scores indicated cognitive impairments in 80% of participants. Hierarchical regression analyses demonstrated that greater pain, fatigue, and depressive symptoms were associated with poorer perceived cognitive functioning. Moderation analyses indicated that taking hormonal treatments or pain medications diminished the adverse effects of depression, but exacerbated the adverse effects of pain, on cognitive functioning. The extensive perceived cognitive difficulties evident in this sample suggests that supportive interventions to enhance cognitive functioning may be warranted.

Neurocognitive predictors of adherence to an online pain self-management program adjunct to long-term opioid therapy

INTRODUCTION

While pain self-management programs can significantly improve patient outcomes, poor adherence is common and the need for research on predictors of adherence has been noted. A potential, but commonly overlooked, predictor is cognitive function. Our aim, then, was to examine the relative influence of various cognitive functional domains on engagement with an online pain self-management program.

METHOD

A secondary analysis of a randomized controlled trial testing the impact of E-health (a 4-month subscription to the online Goalistics Chronic Pain Management Program) plus treatment as usual, relative to treatment as usual alone, on pain and opioid dose outcomes in adults receiving long-term opioid therapy of morphine equivalence dose ≥20 mg; 165 E-health participants who completed an on-line neurocognitive battery were included in this sub-analysis. A variety of demographic, clinical, and symptom rating scales were also examined. We hypothesized that better processing speed and executive functions at baseline would predict engagement with the 4-month E-health subscription.

RESULTS

Ten functional cognitive domains were identified using exploratory factor analysis and the resultant factor scores applied for hypothesis testing. The strongest predictors of E-health engagement were selective attention, and response inhibition and speed domains. An explainable machine learning algorithm improved classification accuracy, sensitivity, and specificity.

CONCLUSIONS

The results suggest that cognition, especially selective attention, inhibitory control, and processing speed, is predictive of online chronic pain self-management program engagement. Future research to replicate and extend these findings seems warranted.

CLINICALTRIALS.GOV REGISTRATION NUMBER

NCT03309188.

Patients' self-reported physical and psychological effects of opioid use in chronic noncancer pain-A retrospective cross-sectional analysis

BACKGROUND

Strong opioids can have unintended effects. Clinical studies of strong opioids mainly report physical side effects, psychiatric or opioid use disorders. To date, too little attention has been paid to the psychological effects of opioids to treat patients with chronic noncancer pain (CNCP). This study aims to identify and measure (i) the nature and frequency of physical and psychological effects and (ii) the degree of physician counseling of patients with CNCP taking strong opioids.

METHODS

Within a cross-sectional survey-conducted as part of a randomised controlled online intervention trial (ERONA [Experiencing the risk of overusing opioids among patients with chronic non-cancer pain in ambulatory care])-300 German CNCP patients were surveyed via patient-reported outcome measures regarding on both the side effects from their use of strong opioids as well as their counselling experience.

RESULTS

Among the patients' reported effects, the psychological outcomes of the opioids in CNCP were: feeling relaxed (84%), fatigue (76%), dizziness (57%), listlessness (37%), difficulty with mental activities (23%), dulled emotions (17%) and poor memory (17%). Ninety-two per cent of the patients reported having received information about opioid effects, and 46% had discussed cessation of the opioid medication with their physicians before commencing the prescription.

CONCLUSIONS

In addition to the well-known physical side effects, patients with CNCP taking strong opioids experience significant psychological effects. In view of these effects, discontinuation of opioid therapy should be discussed early to ensure their benefits do not outweigh their harm.

SIGNIFICANCE

In this study, patients with non-cancer pain notice that opioids they have taken do not only cause physical side effects but also may have an impact on their psyche and their emotions and, thus, may also affect quality of life substantially. Clinical trial number: DRKS00020358.