Association of Regular Opioid Use With Incident Dementia and Neuroimaging Markers of Brain Health in Chronic Pain Patients: Analysis of UK Biobank.
Am J Geriatr Psychiatry
; 32(9): 1154-1165, 2024 Sep.
Article
in En
| MEDLINE
| ID: mdl-38702251
ABSTRACT
OBJECTIVES:
We aimed to investigate the association of regular opioid use, compared with non-opioid analgesics, with incident dementia and neuroimaging outcomes among chronic pain patients.DESIGN:
The primary design is a prospective cohort study. To triangulate evidence, we also conducted a nested case-control study analyzing opioid prescriptions and a cross-sectional study analyzing neuroimaging outcomes. SETTING ANDPARTICIPANTS:
Dementia-free UK Biobank participants with chronic pain and regular analgesic use. MEASUREMENTS Chronic pain status and regular analgesic use were captured using self-reported questionnaires and verbal interviews. Opioid prescription data were obtained from primary care records. Dementia cases were ascertained using primary care, hospital, and death registry records. Propensity score-matched Cox proportional hazards analysis, conditional logistic regression, and linear regression were applied to the data in the prospective cohort, nested case-control, and cross-sectional studies, respectively.RESULTS:
Prospective analyses revealed that regular opioid use, compared with non-opioid analgesics, was associated with an increased dementia risk over the 15-year follow-up (Hazard ratio [HR], 1.18 [95% confidence interval (CI) 1.08-1.30]; Absolute rate difference [ARD], 0.44 [95% CI 0.19-0.71] per 1000 person-years; Wald χ2 = 3.65; df = 1; p <0.001). The nested case-control study suggested that a higher number of opioid prescriptions was associated with an increased risk of dementia (1 to 5 prescriptions OR = 1.21, 95% CI 1.07-1.37, Wald χ2 = 3.02, df = 1, p = 0.003; 6 to 20 OR = 1.27, 95% CI 1.08-1.50, Wald χ2 = 2.93, df = 1, p = 0.003; more than 20 OR = 1.43, 95% CI 1.23-1.67, Wald χ2 = 4.57, df = 1, p < 0.001). Finally, neuroimaging analyses revealed that regular opioid use was associated with lower total grey matter and hippocampal volumes, and higher white matter hyperintensities volumes.CONCLUSION:
Regular opioid use in chronic pain patients was associated with an increased risk of dementia and poorer brain health when compared to non-opioid analgesic use. These findings imply a need for re-evaluation of opioid prescription practices for chronic pain patients and, if further evidence supports causality, provide insights into strategies to mitigate the burden of dementia.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Dementia
/
Chronic Pain
/
Neuroimaging
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Analgesics, Opioid
Limits:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Country/Region as subject:
Europa
Language:
En
Journal:
Am J Geriatr Psychiatry
Journal subject:
GERIATRIA
/
PSIQUIATRIA
Year:
2024
Document type:
Article
Affiliation country:
Reino Unido
Country of publication:
Reino Unido