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Systematic Review and Meta‐Analysis on Neuropsychological Effects of Long‐Term Use of Opioids in Patients With Chronic Noncancer Pain.

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Title: Systematic Review and Meta‐Analysis on Neuropsychological Effects of Long‐Term Use of Opioids in Patients With Chronic Noncancer Pain.
Authors: Allegri, Nicola, Liccione, Davide, Vecchi, Tomaso, Sandrini, Giorgio, Mennuni, Simona, Rulli, Eliana, Corli, Oscar, Floriani, Irene, De Simone, Irene, Biagioli, Elena, Vanacore, Nicola, Allegri, Massimo, Govoni, Stefano
Source: Pain Practice. Mar2019, Vol. 19 Issue 3, p328-343. 16p. 1 Diagram, 12 Charts, 1 Graph.
Subjects: Anticonvulsants, Antidepressants, Therapeutic use of narcotics, Analgesics, Chronic pain, Cognitive testing, Medical information storage & retrieval systems, MEDLINE, Meta-analysis, Narcotics, Neuropsychology, Pain management, Systematic reviews, Statistical significance, Pain measurement
Abstract: Background and Objective: Opioid treatments are often prolonged because of the pathology causing pain. We focused on the cognitive functions in patients with chronic pain treated with opioids. This topic is currently controversial, but in practice, the consequences are important in patients' daily lives, social interactions, working ability, and driving. Database and Data Treatment: Medline and Embase databases were searched for eligible articles. We included studies that enrolled patients with chronic noncancer pain, studies with patients receiving opioid treatment, studies with a control group not using opioids, and studies in which cognitive functions were evaluated with specific tests. The cognitive areas examined were as follows: attention, reaction time, executive functions, psychomotor speed, memory, and working memory. From 356 abstracts screened, 9 articles satisfied eligibility criteria and were included in our review: 7 observational and 7 experimental studies. We classified the pain treatments as follows: opioids, other drugs active on the central nervous system (CNS) (antidepressants/anticonvulsants), and treatments not specifically targeted to the CNS. Results: Statistically significant differences were seen only with regard to attention between opioids alone and no centrally acting treatment (standardized mean difference [SMD]: −0.53, 95% confidence interval [CI] : −0.91, −0.15; P = 0.007; I2 = 23%) and between opioids combined with antidepressants and/or anticonvulsants and no centrally acting treatment (SMD: −0.62, 95% CI: −1.04, −0.20; P = 0.004; I2 = 0%). No other significant differences were observed. Conclusions: Opioids reduce attention when compared with treatments not targeted on the CNS. If opioids are used together with antidepressants and/or anticonvulsants, this effect increases. Significance: These findings on the neuropsychological effects of opioids could be used to generate strategies to refine pain treatments. [ABSTRACT FROM AUTHOR]
Copyright of Pain Practice is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Systematic Review and Meta‐Analysis on Neuropsychological Effects of Long‐Term Use of Opioids in Patients With Chronic Noncancer Pain.
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  Data: Background and Objective: Opioid treatments are often prolonged because of the pathology causing pain. We focused on the cognitive functions in patients with chronic pain treated with opioids. This topic is currently controversial, but in practice, the consequences are important in patients' daily lives, social interactions, working ability, and driving. Database and Data Treatment: Medline and Embase databases were searched for eligible articles. We included studies that enrolled patients with chronic noncancer pain, studies with patients receiving opioid treatment, studies with a control group not using opioids, and studies in which cognitive functions were evaluated with specific tests. The cognitive areas examined were as follows: attention, reaction time, executive functions, psychomotor speed, memory, and working memory. From 356 abstracts screened, 9 articles satisfied eligibility criteria and were included in our review: 7 observational and 7 experimental studies. We classified the pain treatments as follows: opioids, other drugs active on the central nervous system (CNS) (antidepressants/anticonvulsants), and treatments not specifically targeted to the CNS. Results: Statistically significant differences were seen only with regard to attention between opioids alone and no centrally acting treatment (standardized mean difference [SMD]: −0.53, 95% confidence interval [CI] : −0.91, −0.15; P = 0.007; I2 = 23%) and between opioids combined with antidepressants and/or anticonvulsants and no centrally acting treatment (SMD: −0.62, 95% CI: −1.04, −0.20; P = 0.004; I2 = 0%). No other significant differences were observed. Conclusions: Opioids reduce attention when compared with treatments not targeted on the CNS. If opioids are used together with antidepressants and/or anticonvulsants, this effect increases. Significance: These findings on the neuropsychological effects of opioids could be used to generate strategies to refine pain treatments. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Pain Practice is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1111/papr.12741
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        Text: English
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      – SubjectFull: Antidepressants
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      – SubjectFull: Therapeutic use of narcotics
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      – SubjectFull: Narcotics
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      – SubjectFull: Neuropsychology
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      – SubjectFull: Pain management
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      – SubjectFull: Systematic reviews
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      – TitleFull: Systematic Review and Meta‐Analysis on Neuropsychological Effects of Long‐Term Use of Opioids in Patients With Chronic Noncancer Pain.
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