Opioids should not be prescribed for chronic pain after spinal cord injury

Spinal Cord Series and Cases, 2018 · DOI: 10.1038/s41394-018-0095-2 · Published: May 13, 2018

Simple Explanation

Chronic pain is a common issue for individuals with spinal cord injuries (SCI), and finding effective treatments has been challenging. While opioids have been frequently used to manage this pain, their risks and lack of proven benefits are becoming increasingly clear. There are several reasons why opioids should not be used for SCI-related pain. These include the lack of evidence for their long-term effectiveness, the risk of overdose and adverse effects, and the potential for developing an opioid use disorder. For individuals already taking opioids, clinicians should consider slowly tapering them off due to the risks outweighing potential benefits. Alternative pain management interventions should be explored to improve function and quality of life.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Perspective

Key Findings

1
There is a lack of evidence supporting the long-term effectiveness of opioids for treating pain after SCI, except for one small study supporting the effectiveness of tramadol in the short term.
2
Individuals who taper off opioids may experience improvements in function and quality of life, potentially due to the alleviation of adverse effects and the initiation of non-opioid pain management interventions.
3
The risk of opioid overdose increases with higher doses, and persons with cervical and upper thoracic SCI have additional risks due to respiratory insufficiency and polypharmacy.

Research Summary

This perspective argues against the use of opioids for chronic pain after spinal cord injury (SCI), highlighting the lack of evidence for their effectiveness and the significant risks associated with their use. The author outlines four main reasons to avoid prescribing or escalating opioids for SCI-related pain: lack of effectiveness, risk of overdose, adverse effects, and risk of developing an opioid use disorder. The perspective suggests that clinicians should consider tapering opioids off in patients already taking them and explore alternative pain management strategies to improve overall outcomes.

Practical Implications

Clinical Practice Change

Clinicians should reconsider prescribing opioids for chronic pain after SCI, focusing instead on alternative pain management strategies.

Risk Mitigation

For patients already on opioids, a slow tapering approach should be considered to minimize risks of overdose and adverse effects.

Further Research

More research is needed to identify effective non-opioid treatments for chronic pain after SCI.

Study Limitations

1
The perspective is based on the author's viewpoint and may not represent the views of all clinicians.
2
The lack of randomized controlled studies on opioid effectiveness limits the strength of the evidence.
3
The discussion focuses primarily on the risks of opioids and may not fully address the potential benefits for some individuals.

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