Photo Credit: Kubra Cavus

The following is a summary of “Opioid therapy trajectories of patients with chronic non-cancer pain over 1 year of follow-up after initiation of short-acting opioid formulations,” published in the March 2024 issue of Pain by Acharya et al.

Researchers conducted a retrospective study to examine how people who initially use tramadol, hydrocodone, or oxycodone for pain management differ in their long-term opioid use patterns and medications.

They involved adults with chronic non-cancer pain who initiated opioid therapy, using IQVIA PharMetrics ^® Plus for Academics data (2008 to 2018). Enrollment was continuous for six months before (termed “baseline”) and 12 months after (termed “follow-up”) the first opioid prescription (referred to as the “index date”). Opioid therapy measures were evaluated weekly during follow-up. Group-based trajectory modeling (GBTM) was employed to identify trajectories for opioid and total morphine milligram equivalent measures. At the same time, longitudinal latent class analysis was utilized for opioid therapy type assessment.

The results showed 40,276 tramadol, 141,023 hydrocodone, and 45,221 oxycodone initiators were included. GBTM on any opioid therapy revealed three latent trajectories: early discontinuers (tramadol 39.0%, hydrocodone 54.1%, oxycodone 61.4%), late discontinued (tramadol 37.9%, hydrocodone 39.4%, oxycodone 33.3%), and persistent therapy (tramadol 6.7%, hydrocodone 6.5%, oxycodone 5.3%). An additional fourth trajectory, intermittent therapy (tramadol 16.4%), was identified for tramadol initiators. Persistent therapy, 2,687 individuals were on persistent therapy with tramadol, 9,169 with hydrocodone, and 2,377 with oxycodone. GBTM on opioid dose resulted in six similar trajectory groups in each persistent therapy group. Longitudinal latent class analysis on opioid therapy type identified six latent classes for tramadol and oxycodone and seven courses for hydrocodone.

Investigators concluded that the type of opioid initially prescribed significantly impacted long-term use patterns, with tramadol users showing more breaks in therapy and oxycodone users receiving higher opioid doses and long-acting formulations.

Source: academic.oup.com/painmedicine/article-abstract/25/3/173/7577847