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Evidence of Specific Cognitive Deficits in Patients with Low Back Pain under Long-Term Substitution Treatment of Opioids.

Schiltenwolf M, et al.

Journal: Pain Physician. 2014; 17:9-19. 52 references.
Reprint: Halli Wang, MD Dept. of Orthopedic Surgery, Traumatology, And Spinal Cord Injury Center University Hospital of Heidelberg, Schlierbacher Landstr. 2002 69118
Email: halli.wang@med.uni-heihelbergh.de 
Faculty Disclosure: Abstracted by T Newitt, who has nothing to disclose.

Editor's Note:
This is an interesting study on a very important study with tremendous medical legal implications for prescribers but included less than 100 subjects in 2 groups plus controls. The basic question was: do opioids impair cognition? The findings were that chronic pain causes cognitive dysfunction, chronic opioid therapy causes cognitive dysfunction; the interaction of low back pain and treatment with opioids causes dysfunction interaction; and it is possible that the cognitive dysfunction in patients with chronic low back pain may be due to depression or anxiety comorbidities.The literature on this point is mixed with dose escalations usually causing concern for cognitive dysfunction. At least mild cognitive impairment should be assumed with chronic opioid use and appropriate cautions given to patients about hazardous and cognitively demanding activities.

Class:
Psychological aspects of pain and opioid use-Specific Cognitive Deficits in Patients with Low Back Pain under Long-Term Substitution Treatment of Opioids

With increasing opioid use for patients with chronic non-cancer pain, concerns have arisen as to whether this treatment lowers cognitive function in these patients. This is a prospective, nonrandomized cross-sectional study of 37 patients with long-term back pain treated with opioids (OP), 33 patients with the same degree of back pain but without receiving opioids (NO), and 25 healthy controls (HC). These were also referred to as Group 1 (G1), Group 2 (G2), and group 3 (G3) respectively.These subjects were given the same three neuropsychological tests, including Multiple-Choice Vocabulary Test (MWT-B), The Wechsler Adult Intelligence Scale () WAIS-III, Trail Making Test (TMT- A and B slightly different), the Cambridge Neuropsychological Test Automated Battery (CANTAB), Choice Reaction Time ( CRT), Pattern Recognition Memory (PRM), and the Spatial Span (SSP). Anxiety and Depression were measured using the Hospital Anxiety and Depression Scale.“Visual attention, information processing, graphomotor speed, visual scanning ability, numeric sequencing ability are impaired in both patient groups in comparison to the controls.The findings were that chronic pain causes cognitive dysfunction, chronic opioid therapy causes cognitive dysfunction; the interaction of low back pain and treatment with opioids causes dysfunction interaction; and it is possible that the cognitive dysfunction in patients with chronic low back pain may be due to depression or anxiety comorbidities.

Important Points:

"The findings of the current study have research and clinical implications. Clinicians should warn patients that their cognitive functions may not have fully recovered and they may not be fit enough to carry out certain daily activities when they are treated by opioids for a long time."

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