How many Long Term Studies over a year on OPIOID USE??

Chapter 1. How many long term studies of one year or more have been completed in supporting long-term opioid use for CRPS pain management? There appear to be very few long-term studies of one year or more that support long-term opioid use for CRPS pain management. The evidence for long-term opioid use in CRPS is very limited: One study mentioned that CRPS patients were prescribed opioids for an average of 3.95 years, compared to 1.3 years for non-CRPS controls. However, this was an observational study and did not evaluate efficacy or outcomes. A Danish epidemiological study evaluating long-term (>6 months) opioid use in chronic non-cancer pain patients, which may have included CRPS patients, failed to show improvement in health-related quality of life measures. An ongoing FDA-required post-marketing study for extended-release/long-acting opioid analgesics is examining the risk of hyperalgesia following long-term use (at least 1 year) for chronic pain. This study is anticipated to be completed in 2019, but results are not available. Most randomized controlled trials demonstrating opioid efficacy have had small sample sizes and rarely produced data extending past 3 months. A systematic review of open-label extension studies of at least 6-month duration opioid therapy in chronic non-cancer pain was mentioned, but specific results for CRPS were not provided. Opioid prescription rates for Complex Regional Pain Syndrome (CRPS) patients have shown some notable changes over the past decade: Overall Trends A 2023 study found that 70% of CRPS patients were prescribed opioids between 2010-2022, compared to 48% of controls.With CRPS-associated prescriptions specifically, 59% of CRPS patients were prescribed opioids, compared to 49% of controls. From 2010 to 2015, mean opioid doses increased non-significantly in CRPS patients using spinal cord stimulation, from 53 to 120 morphine milligram equivalents (MME) per day. However, a 2023 study noted that opioid prescriptions for CRPS patients increased over time, along with prescriptions for muscle relaxants.The release of the 2016 CDC guidelines for prescribing opioids for chronic pain impacted prescribing practices.There is evidence of significant variance in treatment modalities for CRPS, with some divergence between published recommendations and actual practice.In conclusion, while overall opioid prescribing has decreased in recent years, CRPS patients continue to receive opioid prescriptions at higher rates than the general population. The trend for CRPS-specific opioid prescribing appears to have increased slightly in recent years, despite broader efforts to reduce opioid prescribing. The 2016 CDC guidelines for prescribing opioids had a significant impact on opioid prescription rates, including for Complex Regional Pain Syndrome (CRPS) patients. While the guidelines were not specifically targeted at CRPS, they influenced overall opioid prescribing practices: After the release of the 2016 CDC guidelines, there were accelerated decreases in overall opioid prescribing and declines in potentially high-risk prescribing. The guidelines were associated with an immediate decline in first-time opioid prescriptions at doses of at least 50 morphine milligram equivalents (MME) per day. There was a reduction in the rate of overlapping first-time opioid prescriptions with benzodiazepines among various medical specialties. Despite the general trend of decreasing opioid prescriptions, 70% of CRPS patients were prescribed opioids between 2010-2022, compared to 48% of controls. For CRPS-associated prescriptions specifically, 59% of CRPS patients were prescribed opioids, compared to 49% of controls. The study noted that opioid prescriptions for CRPS patients increased over time, along with prescriptions for muscle relaxants. The impact of the CDC guidelines varied across medical specialties: Family medicine clinicians showed the greatest decrease, with declines accelerating by 4.4 prescriptions per month per 100,000 persons. Surgeons also showed significant decreases, with declines accelerating by 3.6 prescriptions per month per 100,000 persons.