Electrocardiographic and cardiovascular diagnostic characteristics of patients receiving long-term opioid therapy for pain.
OBJECTIVE
To examine cardiovascular and electrocardiogram (ECG) abnormalities seen in patients with chronic pain receiving long-term opioid therapy and to compare them with findings in normal subjects.


METHODS
Clinical pharmaceutical drug trial in a phase I pharmacology unit (normal subjects) and multiple phase 2b study sites (pain patients).


METHODS
Four hundred sixty-one pain patients with constipation due to long-term opioid therapy who were screened for a clinical trial of an investigational treatment for opioid-induced constipation.


METHODS
None; all data used in this study were obtained prior to drug treatment.


METHODS
This is a retrospective analysis of ECG abnormalities and clinical cardiovascular abnormalities in study participants compared with those in a normal reference group of 36,999 subjects.


RESULTS
Numerical ECG values were modestly but not clinically significantly different in the pain patients requiring opioids (mean heart rate +1.5 BPM, PR +5.2 milliseconds, QRS -4.7 milliseconds, and QT corrected for heart rate using the Fridericia formula +7.2 milliseconds). The largest difference in ECG diagnoses between the two groups was a fivefold greater incidence of previous myocardial infarction in the pain patient group (4.1 percent vs 0.8 percent). In addition, 50 percent of the pain patient group had a clinical cardiovascular diagnosis.


CONCLUSIONS
Patients with significant chronic pain requiring opioids have underlying clinical disorders that may be associated with abnormal cardiovascular physiology and ECGs. Clinicians who manage patients with chronic pain should be aware of the higher incidence of cardiovascular disease in this group.
Professor of Medicine, Cardiology Division, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
Jay W
JW
Mason
Formerly Consultant to Theravance, Inc., South San Francisco, California.
Ullrich S
US
Schwertschlag
Theravance, Inc., South San Francisco, California.
Vicki
V
Klutzaritz
Theravance, Inc., South San Francisco, California.
Daniel M
DM
Canafax
D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000503:physiopathology*; D004562:Electrocardiography / Q000187:drug effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology; D010146:Pain / Q000188:drug therapy* / Q000503:physiopathology; D012189:Retrospective Studies
D000701:Analgesics, Opioid