Table 1. Detailed Description of Studies of Opioid Use in Chronic Pain Management.
| Study (References) | Therapy | Patient Population | Findings |
|---|---|---|---|
| Opioids Use in Chronic Pain Management | |||
| A small study at a tertiary referral medical center in Los Angeles, California ( 11 ) | - | 130 patients with CKD | Sources of pain: musculoskeletal (62%); gastrointestinal (13%); genitourinary (10%); hematological/oncological (10%); central and peripheral nervous system (9%); cardiovascular (7%) |
| A prospective cohort study at the University of Alberta ( 30 ) | 26.2% were on weak opioids (codeine, propoxyphene, and oxycodone); 9.7% were on strong opioids (hydromorphone, methadone, fentanyl, and morphine) | 205 Canadian hemodialysis patients | Musculoskeletal pain was most common (50.5%); peripheral neuropathy; peripheral vascular disease pain; effectiveness of therapy was 6% in the patients |
| A cohort study ( 31 ) | Treatment based on a WHO analgesic ladder/algorithm; Over 4 weeks | 45 patients on chronic hemodialysis | 40% nociceptive pain; 31% neuropathic; 29% both; 96% of patients reported adequate analgesia at 4 weeks |
| A retrospective study ( 32 ) | Chronic opioid use before transplantation | 1064 adult kidney transplant patients | Increased risk of death |
| A cross-sectional, observational, multicenter study ( 33 ) | 21% used opioids; 80% used non-opioid analgesics (mainly NSAIDs) | 123 patients with CKD stage 5 on dialysis | Asthenia and fatigue |
| A cohort study between 2011 and 2013 in the Safe Kidney Care in Baltimore, Maryland ( 35 ) | Analgesic prescriptions up to 30 days before visits | 308 patients with CKD | Mild chronic pain: analgesics with a DRP, with OR of 3.04; severe chronic pain: analgesics with a DRP, with OR of 5.46 |
| A cohort study from a single center ( 37 ) | 52 patients were long-term opioid recipients; 78 patients had opioid for fewer than 90 days; 8 patients had only a non-opioid prescription | 191 HD patients | Findings of this study may not be generalizable to all HD patients due to the small sample size from one setting |
| A cohort study of the US Renal Data System ( 39 ) | Over 60% of dialysis patients received at least one opioid; 20% had chronic opioid prescription (≥ 90-day supply) | 671,281 patients on maintenance dialysis | Most prescribed opioids: hydrocodone (11.7%); oxycodone (5.4%); tramadol (2.5%); propoxyphene (1.4%) |
| A cohort study in Ontario, Canada, between August 1, 1997, and December 31, 2013 ( 40 ) | Simultaneous gabapentin use in 120 days; gabapentin dose as low (< 900 mg daily), moderate (900 to 1,799 mg daily), and high (-1,800 mg daily); concomitant (NSAID) use in the preceding 120 days | 1,256 opioid users died of an opioid-related cause; 4,619 controls also used opioids | Co-prescription of opioids and gabapentin was correlated with a considerably increased odds of opioid-related death; no significant association between co-prescription of opioids and NSAIDs and opioid-related death |
| A cohort study using the US Renal Data System ( 41 ) | 64% of patients received opioids | 140,899 adults receiving hemodialysis | Opioid use was associated with a risk of: Altered mental status; fall; fracture |
| A cohort study in Geisinger Health System, in Pennsylvania, and Johns Hopkins Medicine, in Maryland ( 42 ) | 31.8% received at least one opioid prescription in Geisinger; -22.7% received at least one opioid prescription in Johns Hopkins Medicine | In 2016; 181,107 patients in Geisinger; 109,219 patients in Johns Hopkins Medicine | Gabapentin and pregabalin prescriptions were less common in the overall cohort at 9.9% of Geisinger and 6.3% of Johns Hopkins Medicine; NSAID use was similar across the two cohorts and was lower in patients with lower eGFR in both cohorts; -prescription opioids: methadone and buprenorphine were 0.9% at Geisinger and 0.3% at Johns Hopkins Medicine |
| A prospective observational study between May 1996 and September 2001 (DOPPS) ( 43 ) | Dialysis patients: 15% were on an opioid; 1.7% on an opioid with acetaminophen; 1.2% on an opioid with COX-2; -0.6% on an opioid with NSAIDs | 3749 dialysis patients | The proportion of patients prescribed any analgesic decreased from 30.2% to 24.3%; narcotic prescriptions decreased from 18.0% to 14.9%; propoxyphene and acetaminophen were most commonly prescribed (47.2%) |
| A prospective cohort study ( 44 ) | Chronic opioid derivative | 308 patients on thrice-weekly HD | 12.7% with a median age of 74.7 years fell at least once during 8 weeks; 3.9% experienced a fall-related fracture during 12 months; 28% who fell were on an opioid derivative; 9.7% were not on opioids |
| A prospective cohort study ( 45 ) | Opioid; benzodiazepines; + opioid; adrenal cortical; steroids; antidepressants | 12,782 HD patients | Opioid pain medications; combination opioid medications |
Abbreviations: aHR, adjusted hazard ratio; CI, confidence interval; CKD, chronic kidney disease; DOPPS, dialysis outcomes and practice patterns study; DRP, drug-related problem; ESRD, end-stage renal disease; HD, hemodialysis; HRQOL, health-related quality of life; HR, hazard ratio; HTEMS, high-tone external muscle stimulation; IRR, incidence rate ratio; LHID2000, longitudinal health insurance database 2000; NHRI, National Health Research Institutes; NSAID, nonsteroidal anti-inflammatory drugs; OR, odds ratio; QoL, quality of life; RCT, randomized clinical trial; WHO, World Health Organization.