Persistent pain is an important public health issue linked to an increased risk of death. Evidence suggests that globally about 3 in 10 people experience chronic pain, which may in some cases be linked to an unhealthy lifestyle. Pain management approaches can include physical activity, as well as physical, behavioural and relaxation therapies. Painkillers, otherwise known as analgesics, are also in widespread use. Some painkillers are addictive and can be detrimental. In North America, particularly the United States, there is a well documented opioid use crisis.
A new study led by Cathy Stannard of NHS Gloucestershire Clinical Commissioning Group, UK, addressed the question of opioid use in the UK, the status of associated markers of health, and the risk of mortality. The study made use of data from the UK biobank with the results published in the journal EClinicalMedicine.
Current and prior cancer patients were excluded from the study. Of the remaining participants 6% self-reported regular use of opioid medication. In North-East England the rate rose to 8%. Of those that were not working because of ill-health, 34% were taking opioids. Self-reported poor health and low physical activity was associated with opioid use.
Combined preparations were most common, followed by codeine and dihydrocodeine. The most common strong opioids were tramadol > morphine > buprenorphine. Users of regular opioids were more likely to use a single opioid > 2 > 3.
Most (88%) self-reported users of opioid medication also reported chronic pain, poor quality sleep, insomnia, and poorer mental health. Those reporting more than one of these risk factors had a greater likelihood of opioid use.
During follow-up, mortality among those taking weak opioids was 7%, and 9% for those taking strong opioids. This compared with 3% among those not taking opioids.
Evidence suggests that the people who took part in the UK biobank were healthier than the general population. At age 70-74 years, all-cause mortality was shown to be 46% and 56% lower in men and women, respectively than the wider population. The rates of opioid use in the study are therefore likely to be to be underestimated relative to the UK population as a whole. Although the statistical associations model of opioid use was adjusted for confounding by chronic pain, there may still be some residual confounding. Opioid use was self-reported and no information was available on the doses being used.
“This study adds to current evidence in showing that regular [opioid] users also experience an increased risk of death (but not primarily as a result of non-disease deaths). It emphasises the need to take into account such potential harms and lack of benefit of regular opioid use in considering the long-term management of patients with pain,” concluded the authors.