ArticleJournal of general internal medicine2020
Complex Persistent Opioid Dependence with Long-term Opioids: a Gray Area That Needs Definition, Better Understanding, Treatment Guidance, and Policy Changes.
Article in Journal of general internal medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
30 citing papers in PubMed, 3 syntheses or guidelines pooled it, 53 citations in OpenAlex.
- Impact of treatment duration on the effectiveness of opioid analgesia: a systematic review and meta-analysis.The British journal of general practice : the journal of the Royal College of General Practitioners · 2026Pooled it
- Efficacy of interventions to reduce long term opioid treatment for chronic non-cancer pain: systematic review and meta-analysis.BMJ (Clinical research ed.) · 2022Pooled it
- Treatment-seeking behaviour among people with opioid use disorder in the high-income countries: A systematic review and meta-analysis.PloS one · 2021Pooled it
- Patient Profiles of Buprenorphine Initiators in General Healthcare Settings: A Latent Class Approach.Journal of general internal medicine · 2026Article
- Pain assessment tools in patients with substance use disorders: a systematic scoping review.Addiction science & clinical practice · 2026Article
- Chronic Pain and Opioids in the Elderly: Treating the Brain, Not Just the Body.International journal of environmental research and public health · 2026Review
- The Impact of Opioids on Epigenetic Modulation in Myocardial Ischemia and Reperfusion Injury: Focus on Non-coding RNAs.Journal of cardiovascular translational research · 2025Review
- Opioid use patterns and persistent use after hemodialysis access surgery.Journal of vascular surgery · 2025Article
- Wireless, battery-free, remote photoactivation of caged-morphine for photopharmacological pain modulation without side effects.Biosensors & bioelectronics · 2025Article
- Opioid Use and Prescription Opioid Use Disorder: Biopsychosocial Characterisation of a Clinical Chronic Pain Cohort.European journal of pain (London, England) · 2025Article
- Low-dose ketamine infusion to facilitate opioid tapering in chronic non-cancer pain with opioid-use disorder: a historical cohort study.Regional anesthesia and pain medicine · 2025Article
- Are opioids effective analgesics and is physiological opioid dependence benign? Revising current assumptions to effectively manage long-term opioid therapy and its deprescribing.British journal of clinical pharmacology · 2024Review
- Bridging the Gap: Promoting Interventional Pain Medicine as a Future for Family Physicians.Cureus · 2024Review
- Opioid Use Disorder: A Qualitative Exploratory Analysis of Potential Misunderstandings in Patients with Chronic Non-Cancer Pain.Journal of pain research · 2024Article
- Abdominal Pain in Inflammatory Bowel Disease: An Evidence-Based, Multidisciplinary Review.Crohn's & colitis 360 · 2023Article
- Changes in Psychological Outcomes after Cessation of Full Mu Agonist Long-Term Opioid Therapy for Chronic Pain.Journal of clinical medicine · 2023Article
- Variation in Clinical Characteristics and Longitudinal Outcomes in Individuals with Opioid Use Disorder Diagnosis Codes.Journal of general internal medicine · 2023Observational
- External validation of a model to predict future chronic opioid use among hospitalized patients.Journal of hospital medicine · 2023Article
- Primary care management of Long-Term opioid therapy.Annals of medicine · 2022Review
- Complex Persistent Opioid Dependence-an Opioid-induced Chronic Pain Syndrome.Current treatment options in oncology · 2022Review
Corrections and comments
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Authors and funding
5 authors at 3 institutions in 1 country.
Funding
Abstract
The multitude of treatments available for tens of millions of US adults with moderate/severe chronic pain have limited efficacy. Long-term opioid therapy (LTOT) is a widely available option for controlling pain among patients with chronic pain refractory to other treatments. The recent recognition of LTOT inefficacy and complications has led to more frequent opioid tapering, which in turn has revealed its own set of complications. The occurrence of the same set of symptoms-worsening pain, declining function, and clinical instability-in contrasting contexts of LTOT ineffectiveness and opioid tapering has led to increasing recognition of the utility of complex persistent opioid dependence (CPOD), a clinically distinct but biologically similar state compared with opioid use disorder as an explanatory diagnosis/heuristic. Recent guidelines for LTOT tapering have incorporated buprenorphine treatment based on CPOD concepts as a recommended treatment for problems due to opioid tapering with limited supportive evidence. The increasing utilization of buprenorphine for both LTOT ineffectiveness and opioid tapering problems raises the urgent need for a review of the clinical definition, mechanisms, and treatment of CPOD and pertinent policies. In this manuscript, we discuss various issues related to CPOD that requires further clarification through research and policy development.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.