| Title: | Association of regular opioid use with incident dementia and neuroimaging markers of brain health in chronic pain patients: analysis of UK Biobank |
| Journal: | American Journal of Geriatric Psychiatry |
| Published: | 21 Apr 2024 |
| Pubmed: | https://pubmed.ncbi.nlm.nih.gov/38702251/ |
| DOI: | https://doi.org/10.1016/j.jagp.2024.04.010 |
| Citations: | 1 (1 in last 2 years) as of 8 Aug 2024 |
Publication 10003
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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.</p>
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.</p>
SETTING AND PARTICIPANTS: Dementia-free UK Biobank participants with chronic pain and regular analgesic use.</p>
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.</p>
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.</p>
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.</p>
17 Keywords
- Aged
- Analgesics, Opioid
- Biological Specimen Banks
- Brain
- Case-Control Studies
- Chronic Pain
- Cross-Sectional Studies
- Dementia
- Female
- Humans
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Neuroimaging
- Prospective Studies
- UK Biobank
- United Kingdom
9 Authors
- Yaqing Gao
- Binbin Su
- Lei Ding
- Danial Qureshi
- Shenda Hong
- Jie Wei
- Chao Zeng
- Guanghua Lei
- Junqing Xie
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