Limited Evidence for Long-Term Opioid Use in Chronic Pain Patients, Preliminary Data Show

AUSTIN, Texas—According to the CDC, there are very few studies assessing the long-term benefits of opioid use for chronic pain lasting three months or more, with outcomes evaluated at least one year after treatment initiation.
At the American Academy of Pain Medicine 2025 PainConnect conference, investigators presented preliminary data analyzing self-reported adherence, aberrant behavior and compliance events in relation to patient functional outcomes. The study evaluated 1,540 patients with chronic pain who received long-term opioid therapy (LTOT) over a 36-month period.

“Despite this observation, long term opioid therapy (LTOT) is utilized by at least 9 million patients, among a population of 24 million adults diagnosed with high impact chronic pain and the backdrop of a growing national chronic pain population,” the authors wrote. “LTOT adherence, aberrance and compliance events identify risks of patient harm and increased prescriber liability.”

In the study, each patient received care from seven providers across five practices in two Western U.S. states. As a condition of receiving LTOT, patients were required to attend a monthly telemedicine group education session hosted by pain specialists. They also completed monthly self-administered psychometric and functional monitoring assessments, along with individual or group follow-up appointments (either in person or via telemedicine) coinciding with opioid prescription renewals.

The investigators reviewed the self-reported data, functional monitoring data and appointment history data to establish patient treatment adherence, compliance and aberrance risk. They also conducted morphine milligram equivalent (MME) calculations and prescriber and controlled substance fill dates using prescription drug monitoring program records. 

Adherence was classified by six categories, according to the relationship with the chronic pain opioid standard of care. 

The results show older patients received slightly lower MME. However, this effect was minimal, and there were no meaningful correlations between MME and benzodiazepine use as well as MME and aberrant behavior flags. 

However, there was a strong negative correlation found between potential aberrant behavior and no aberrant behavior, and a moderate correlation between cognitive issues and potential aberrant behavior. 

Finally, they found a correlation between “medication misuse is associated with cognitive issues” and potential aberrant behavior as well as a low to moderate correlation between self-harm risk and cognitive issues and medication misuse, and emergency visits show a weak correlation with potential aberrant behavior. 

—Kenny Walter