A long-term use of certain medicines could be linked to a high risk of fracture nonunion, a new study has found. Following a major surgery, nearly 49.2 percent of the patients receive an opioid prescription during a discharge for the management of post-operative pain. Even then, there is a dearth of evidence supporting that opioids could be more effective than the non-opioids for treating acute extremity pain, especially in the emergency care.
The study authors suggested the adoption of multimodal, non-opioid options for managing fractures as most of the opioid analgesics come with high risk. The researchers analyzed the data of 309,330 patients with 18 most common types of fractures for their medication usage comprising opioid analgesics, nonopioid analgesics, antidiabetic medication, diuretics, steroids, cardiac drugs, drugs for osteoporosis, antibiotics, immune suppressants, and anticoagulants.
It was found that the opioid use was associated with a high susceptibility to fracture nonunion even if the administration was for acute or chronic purposes. Lead author Dr. Robert Zura reported that the chronic usage was associated with double the risk on fracture reunion and it was constant across both genders and all age groups.
The researchers reported that relative to the non-opioid analgesics, the entire group of Schedule II opioids heighten the risk of nonunion. A noteworthy risk is produced by some of these medicines like meperidine, oxycodone, hydrocodone/ acetaminophen, hydromorphone, acetaminophen/oxycodone. Naloxone/pentazocine and tramadol from Schedule III-V were also linked with an increase in the risk. On the other hand, buprenorphine, acetaminophen/codeine were not linked to an increased threat for nonunion. The risk of nonunion got exacerbated with the chronic use of prescribed non-steroidal anti-inflammatory drugs (NSAIDs).
Dr. Zura said that the recent opioid policy encourages the use of low potency opioids like tramadol in comparison to the use of high potency drugs. However, this might not suffice in attaining the medication safety required to the desired level. He also emphasized that the trauma surgeons and related physicians must analyze the nonunion risk developed by the medication usage.
Long-term opioid therapy
Long-term use of opioids is associated with gastrointestinal side effects like constipation, nausea, abdominal cramping, spasms and bloating. Chronic use can also cause sleep-related breathing problems like ataxic or irregular breathing. There are also some cardiovascular adverse effects like myocardial infarction and heart failure. Hyperalgesia or heightened sensitivity to pain is also observed with opioid use. This might cause acute pain following a surgery and increased dosage of opioids.
Opioids can also cause an increased risk of fracture, especially among the elderly because their use can hamper alertness and cause dizziness, thus increasing the risk of falling and fracturing the bones. Hormonal dysregulation can also arise from the long-term opioid use.
In men, opioids can cause hypogonadism, which can lead to reduced synthesis of testosterone, lowered libido, fatigue, erectile dysfunction and even hot flashes. In women, opioids can be associated with low levels of estrogen, increased prolactin and low levels of follicle stimulating hormone. Chronic use of opioids is also linked with the increased susceptibility to depression.
Road to recovery
Long-term use of opioids is also associated with misuse and addiction. Opioid addiction can have a major impact on one’s physical and mental health, relationships, finances, productivity, and it may lead to problem with the law. Therefore, one must seek timely drug abuse help from drug abuse clinic to reverse the effects.