The public perception of opioids is not good right now. Thousands of people around the United States die each year due to opioid overdoses. But doctors prescribe them for a reason; they’re good at alleviating pain. Many, though, given the addictive qualities of opioids, are prescribing different regimens for their patients.
A new study by a WSU medical researcher shows that, in many cases, those other regimens are just as good at controlling pain. Dr. Sterling McPherson is an associate professor of medicine and director of biostatistics and clinical trial design. He and a colleague at Oregon Health and Sciences University have found that, for many patients who no longer take opioids, their pain has remained the same or even lessened.
McPherson and his colleague examined the records of about 550 patients in the V-A system. They were patients who had been prescribed opioids for at least a year to treat chronic pain and then were removed from opioid regimens by their doctors.
Sterling McPherson: “We really don’t know what happens after patients have been discontinued after long-term opioid therapy and I think sometimes people are surprised to hear that’s a relatively large swath of patients who are in the health care system who have been on opioids a long time.”
Doug: “So it seems the goal is to run away from opioids as much as possible, given what has happened to so many people. Anything that is an alternative to an opioid. Is that the motivation behind this study?”
Sterling McPherson: “Not necessarily THE motivation, though I can certainly appreciate what you’re saying. It’s certainly true that we want to manage chronic pain in the most effective means possible and I think our question here was can opioids provide that? We know that opioids can be an effective tool and sometimes that’s not said very much right now, but for people who just had their wisdom teeth pulled out or just had major surgery or who have cancer, opioids are often a very effective treatment modality. But the question here is is it effective for other types of chronic pain. We’re not saying that it should never, ever be used. In this sample, it just appears that it wasn’t effective at managing chronic pain. The necessary followup question is what is effective?”
Doug: “So is it fair to say there’s no blanket idea for opioids for people as a whole? That there are so many individual differences that it’s really difficult to figure out if there is one thing that’s going to work for people?”
Sterling McPherson: “Absolutely. That’s one thing that we talk about in this paper is just that chronic pain varies widely and it’s difficult to predict. The fact that people change so much compared to themselves over time. So if I give you a pain rating scale that’s a 4 today, it may be 8 in a week or two, and that fluctuates a lot and that’s on a scale of 1-10. So it makes it difficult to predict what my pain is going to be several months from now and so I think that’s what’s led to a necessary deeper dive to what are people doing to manage their chronic pain and how do we most effectively provide treatments for certain groups of people; group A, where this treatment may be effective, v versus group B, where another treatment may be effective. There’s a lot of work to be done to sort that out.”
Doug: “You as a substance abuse researcher, do you notice that there’s an urgency on opioid research right now simply because of the societal damage that they’ve done? Has this become a public health emergency and therefore, research is going on because of that?”
Sterling McPherson: “It’s absolutely a public health emergency. I don’t think there’s any dispute about that. I think, as a result, and it’s not just people who are using drugs illicitly, but many people who are using drugs legally, in fact, in consultation with their provider; in fact, in this study, that was the majority of our patients. We screened out patients who were on methadone or suboxone or receiving any kind of treatment for an opioid use disorder. That was intentional on our part. This question of where do opioids fit into the care of patients is a larger question that just are people developing a use disorder and, if they are, what do we do about it? Unfortunately, the opioid epidemic has grown tentacles into chronic pain, into depression, into a variety of other therapeutic areas that are now going to be investigated as a result of where we find ourselves.”
Doug: “So give me an idea of how this fits into the opioid research that’s been done?
Sterling McPherson: “There have been lots of investigations into whether or not opioid therapy is effective for chronic pain and people have examined that in migraine pain, in back pain, in chest pain. Lots of different types. This is a comprehensive study of all different types of pain and it’s in a large representative sample. I think that’s what it adds to the literature. What we were able to do is examine not just whether or not, on average, people’s pain changed after long-term opioid therapy, but did it change differently for people who started out with mild versus moderate versus severe pain? And we basically found that it’s true regardless of what level of pain you have, which I think is a unique contribution as well.”
Sterling McPherson is the director of biostatistics and clinical trial design at WSU’s College of Medicine.