Opioid Therapy in Chronic Pain: Assessment of Clinical Outcomes and Relationships With Endocrine Biomarkers

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain Pub Date : 2025-04-29 DOI:10.1002/ejp.70027

Dalia Abou-Kassem, Pernille Døssing Kwateng Diasso, Per Sjøgren, Katharina Maria Main, Susanne Dam Nielsen, Geana Paula Kurita

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Abstract

Background

Long-term opioid treatment (L-TOT) may have consequences that are mediated by factors affecting functionality and health-related quality of life. This study aimed at investigating associations between L-TOT and clinical outcomes including sustained attention, short-term and working memory, worst pain intensity, sleep quality, mood, and health-related quality of life in patients with chronic non-cancer pain (CNCP). Additionally, the study aimed at exploring whether endocrine biomarkers mediate the relationship between L-TOT and these outcomes.

Methods

Cross-sectional study with 82 adult CNCP patients divided into two groups (opioid treated (n = 38) and controls not treated with opioids (n = 44)). Linear regression analyses assessed associations between L-TOT, outcome variables, and the mediating effects of endocrine biomarkers.

A Bootstrap approach with 95% confidence intervals was applied to analyse the natural indirect effect.

Results

The opioid group had worse sleep quality (p = 0.018), physical functioning (p = 0.0186), social functioning (p = 0.002), and higher pain intensity (p < 0.001) compared with controls. Men in the L-TOT group experienced worse measures for the same variables, and additionally for anxiety (p = 0.028), depression (p = 0.040), role physical (p = 0.038), role emotional (p < 0.001), fatigue (p = 0.019), and emotional well-being (p = 0.001). Only the association between L-TOT and anxiety in men was significantly mediated by total testosterone (β = 1.6, Bias-Corrected Bootstrap 95% CI: 0.1; 4.1, p = 0.045).

Conclusions

CNCP patients in L-TOT showed significantly poorer outcomes than controls. Only testosterone mediated anxiety in men, indicating a natural indirect effect. Causality and mediating effects of endocrine biomarkers need to be further explored, but the associations are an alert to the potential effects of opioids.

Significance Statement

This study reveals the broader health impacts of opioid use, particularly the role of hormone-related factors in men, which may be linked to specific adverse effects and consequences. Investigating these hormonal dynamics could lead to improved treatment strategies and outcomes.

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阿片类药物治疗慢性疼痛：评估临床结果和与内分泌生物标志物的关系

背景长期阿片类药物治疗（L-TOT）可能会产生影响功能和健康相关生活质量因素介导的后果。本研究旨在探讨L-TOT与慢性非癌性疼痛（CNCP）患者的临床结果（包括持续注意力、短期和工作记忆、最严重疼痛强度、睡眠质量、情绪和健康相关生活质量）之间的关系。此外，本研究旨在探讨内分泌生物标志物是否介导L-TOT与这些结果之间的关系。方法对82例成人CNCP患者进行横断面研究，分为阿片类药物治疗组（n = 38）和非阿片类药物治疗组（n = 44）。线性回归分析评估了L-TOT、结局变量和内分泌生物标志物的中介作用之间的关联。采用95%置信区间的Bootstrap方法分析自然间接效应。结果阿片类药物组睡眠质量（p = 0.018）、身体功能（p = 0.0186）、社交功能（p = 0.002）、疼痛强度（p < 0.001）较对照组差。L-TOT组的男性在同样的变量上经历了更差的测量，另外在焦虑（p = 0.028）、抑郁（p = 0.040）、角色身体（p = 0.038）、角色情感（p < 0.001）、疲劳（p = 0.019）和情感健康（p = 0.001）方面也经历了更差的测量。只有男性L-TOT与焦虑之间的关联被总睾酮显著介导(β = 1.6，偏差校正Bootstrap 95% CI: 0.1；4.1, p = 0.045)。结论CNCP患者L-TOT预后明显差于对照组。只有睾酮能调节男性的焦虑，这表明它有自然的间接影响。内分泌生物标志物的因果关系和中介作用有待进一步探讨，但这些关联是对阿片类药物潜在影响的警示。本研究揭示了阿片类药物使用对健康的更广泛影响，特别是激素相关因素在男性中的作用，这可能与特定的不良影响和后果有关。研究这些激素动态可以改善治疗策略和结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Pain 医学-临床神经学

CiteScore

7.50

自引率

5.60%

发文量

163

审稿时长

4-8 weeks

期刊介绍： European Journal of Pain (EJP) publishes clinical and basic science research papers relevant to all aspects of pain and its management, including specialties such as anaesthesia, dentistry, neurology and neurosurgery, orthopaedics, palliative care, pharmacology, physiology, psychiatry, psychology and rehabilitation; socio-economic aspects of pain are also covered. Regular sections in the journal are as follows: • Editorials and Commentaries • Position Papers and Guidelines • Reviews • Original Articles • Letters • Bookshelf The journal particularly welcomes clinical trials, which are published on an occasional basis. Research articles are published under the following subject headings: • Neurobiology • Neurology • Experimental Pharmacology • Clinical Pharmacology • Psychology • Behavioural Therapy • Epidemiology • Cancer Pain • Acute Pain • Clinical Trials.