title: Health-related quality of life in patients receiving long-term opioid therapy: a systematic review with meta-analysis.
abstract: Over 25 million Americans reported having daily pain and between 5 and 8 million Americans used opioids to treat chronic pain in 2012. This is the first systematic review with meta-analysis to determine the effects of long-term opioid use on the Physical Component Summary (PCS) score and Mental Component Summary (MCS) scores of a Health-Related Quality of Life instrument in adults without opioid use disorder.
  
  
  
  The a priori eligibility criteria for the PubMed (MEDLINE), Scopus, and PsyINFO searches were (1) randomized controlled trial, (2) at least one opioid intervention group, (3) minimum of 4-week duration of opioid use, (4) comparative control group, and (5) adults ≥18 years that do not have dominant disease. The unit of analysis was the standardized mean difference effect size (Hedges's g). All results were pooled using random-effects models.
  
  
  
  Of the 340 non-duplicate citations screened, 19 articles comprising 26 treatment comparisons and 6168 individuals (treatment n = 3160; comparators n = 3008 with duplicates removed) met the inclusion criteria for the systematic review. Thirteen treatment comparisons were available for the meta-analysis. Across all PCS analyses, small, statistically significant improvements were observed (opioid versus opioid only: g = 0.27, 95% CI 0.05-0.50, opioid versus placebo only: g = 0.18, 95% CI 0.08-0.28, and all studies combined: g = 0.22, 95% CI 0.11-0.32). There were small but not statistically significant changes on the MCS scores. Overall, high heterogeneity was present.
  
  
  
  PCS scores improve with no change in MCS scores. However, long-term opioid trials are rare and only two trials included lasted longer than 1 year.
authors.affiliation: Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Robert C. Byrd Health Sciences Center (North), P.O. Box 9510, Morgantown, WV, 26506-9510, USA.
authors.forename: J Douglas
authors.initials: JD
authors.lastname: Thornton
authors.affiliation: Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Robert C. Byrd Health Sciences Center (North), P.O. Box 9510, Morgantown, WV, 26506-9510, USA.
authors.forename: Rashmi
authors.initials: R
authors.lastname: Goyat
authors.affiliation: Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Robert C. Byrd Health Sciences Center (North), P.O. Box 9510, Morgantown, WV, 26506-9510, USA. nidwibedi@hsc.wvu.edu.
authors.forename: Nilanjana
authors.initials: N
authors.lastname: Dwibedi
authors.affiliation: Department of Biostatistics, School of Public Health, West Virginia University, Morgantown, WV, USA.
authors.forename: George A
authors.initials: GA
authors.lastname: Kelley
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D006801:Humans; D009293:Opioid-Related Disorders / Q000523:psychology*; D018434:Sickness Impact Profile
chemical_list: D000701:Analgesics, Opioid
keywords: Health-related quality of life; Meta-analysis; Opioid; Randomized controlled trials; Systematic review