Presented at the 2013 AAPM Annual Meeting « Back

Improvement in Physiologic but Not Hormonal Functions After 10 Years of Opioid Treatment

Forest Tennant, MD PhD, veractinc@msn.com¹, (1) Veract Intractable Pain Clinic, West Covina, California

Introduction/Statement of the Problem: There is limited knowledge about the outcomes of long-term opioid therapy in non-cancer patients. Methods and Materials: Between July and October 2012, 40 patients who had been in high dose opioid therapy (over 100 mg equivalence of morphine a day) for 10 or more years were evaluated. Patients all met the California definition of intractable which is “incurable by any known means”. All had experienced multiple non-opioid therapies prior to opioid treatment and all claimed constant, debilitating pain with severe insomnia. Evaluation consisted of two written questionnaires and testing for serum cortisol, pregnenolone, corticotropin (ACTH), testosterone, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). Questions asked about improvement in 17 physiologic functions including reading, hearing, concentration, memory, driving, sleep, movement, dressing, and libido. The other questionnaire asked about depression, hopelessness, and quality of life before and during opioid treatment. Results: All 40 patients reported sustained pain control on a stable opioid dosage and improvements in multiple physiologic functions, depression, hopelessness, and quality of life. Hormone deficiencies were found in almost 50% which required replacement in most cases. High inflammatory markers (ESR, CRP) were present in about 20%. Conclusions: The high dose opioid patients studied here greatly improved many physiologic functions as well as mental outlook on depression, hopelessness, and quality of life. Hormonal suppression was a significant complication in these patients.

Funding: None