Systematic Review
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2019; 7(24): 4254-4269
Published online Dec 26, 2019. doi: 10.12998/wjcc.v7.i24.4254
Chronic pain, posttraumatic stress disorder, and opioid intake: A systematic review
Alicia E López-Martínez, Ángela Reyes-Pérez, Elena Rocío Serrano-Ibáñez, Rosa Esteve, Carmen Ramírez-Maestre
Alicia E López-Martínez, Ángela Reyes-Pérez, Elena Rocío Serrano-Ibáñez, Rosa Esteve, Carmen Ramírez-Maestre, Facultad de Psicología, Instituto de Investigaciones Biomédicas (IBIMA), Universidad de Málaga, Málaga 29071, Spain
Author contributions: All authors equally contributed to this paper.
Conflict-of-interest statement: The authors have no conflict of interest for this manuscript.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Elena Rocío Serrano-Ibáñez, MSc, PhD, Postdoctoral Fellow, Facultad de Psicología, Instituto de Investigaciones Biomédicas (IBIMA), Universidad de Málaga, Campus de Teatinos, Málaga 29071, Spain. elenarserrano@uma.es
Telephone: +34-95-63578781
Received: April 13, 2019
Peer-review started: April 15, 2019
First decision: September 9, 2019
Revised: October 17, 2019
Accepted: November 26, 2019
Article in press: November 26, 2019
Published online: December 26, 2019
Processing time: 257 Days and 3.5 Hours
Abstract
BACKGROUND

The literature suggests that there is a high degree of co-occurrence between chronic pain and posttraumatic stress disorder (PTSD). An association has been found between PTSD and substance abuse. PTSD is a severe disorder that should be taken into account when opioids are prescribed. It has been found that the prevalence of opioid use disorder (OUD) in chronic pain patients is higher among those with PTSD than those without this disorder.

AIM

To perform a systematic review on the association between PTSD, chronic non-cancer pain (CNCP), and opioid intake (i.e., prescription, misuse, and abuse).

METHODS

We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Patient, Intervention, Comparator, and Outcomes (PICOS) criteria were formulated a priori in the protocol of the systematic review. A search was conducted of the PROSPERO database. In March 2019, searches were also conducted of 5 other databases: PubMed, MEDLINE, PsycINFO, Web of Science, and PILOTS. The Scottish Intercollegiate Guidelines Network checklist for cohort studies was used to assess the selected studies for their methodological quality and risk of bias. Each study was evaluated according to its internal validity, participant sampling, confounding variables, and the statistical analysis.

RESULTS

A total of 151 potentially eligible studies were identified of which 17 were retained for analysis. Only 10 met the selection criteria. All the studies were published between 2008 and 2018 and were conducted in the United States. The eligible studies included a total of 1622785 unique participants. Of these, 196516 had comorbid CNCP and PTSD and were consuming opiates. The participants had a cross-study mean age of 35.2 years. The majority of participants were men (81.6%). The most common chronic pain condition was musculoskeletal pain: back pain (47.14% across studies; range: 16%-60.6%), arthritis and joint pain (31.1%; range: 18%-67.5%), and neck pain (28.7%; range: 3.6%-63%). In total, 42.4% of the participants across studies had a diagnosis of PTSD (range: 4.7%-95%). In relation to opioid intake, we identified 2 different outcomes: opioid prescription and OUD. All the studies reported evidence of a greater prevalence of PTSD in CNCP patients who were receiving prescribed opioids and that PTSD was associated with OUD in CNCP patients.

CONCLUSION

Opioid analgesic prescription as the treatment of choice for CNCP patients should include screening for baseline PTSD to ensure that these drugs are safely consumed.

Keywords: Posttraumatic stress disorder, Chronic pain, Opioid prescription, Opioid misuse, Opioid abuse

Core tip: In the management of chronic pain, co-morbid posttraumatic stress disorder (PTSD) plays a critical role in opioid misuse or abuse. The present systematic review found that the study participants with comorbid PTSD and chronic non-cancer pain received higher doses of opioids, received more than 1 type of opioid concurrently, and were more likely to receive chronic opioids.