Clinical Instruments Assessing Harms and Benefits of Long-Term Opioid Therapy for Chronic Pain: A Scoping Review

While rates of opioid prescribing for chronic non-cancer pain have declined, long-term opioid therapy (LTOT) remains common. Current clinical guidelines emphasize the importance of continuous reassessment and weighing of harms and benefits associated with LTOT to inform treatment decisions. However, specific guidance on which harms and benefits to assess and how to weigh these factors is generally lacking. This scoping review aimed to identify and characterize clinical instruments used to assess opioid-related harms and benefits in adults receiving LTOT for chronic non-cancer pain with a focus on instrument content domains and weighing of harms and benefits.

Study selection was guided by the Population, Concept, Context (PCC) framework. Studies were included if they described clinical assessment instruments used in adults prescribed LTOT (≥ 90 days) for chronic, non-cancer pain. We searched multiple databases and screened records using a multi-coder process. Data were extracted on instrument characteristics, content domains, individual items, and scoring.

From eight thousand, seven hundred thirty-eight records, 37 studies describing 25 instruments were included. Most instruments were self-administered by patients. All instruments assessed harms (either current or potential). Of the 448 total items contained in the 25 included instruments, 12% assessed current or potential benefits (including efficacy of analgesia, functional improvement, and quality of life) and 88% assessed harms (including misuse and safety concerns). Instruments prioritized assessment of current or potential harms over assessment of current or potential benefits of LTOT.

Existing instruments for monitoring LTOT predominantly assess harms-particularly misuse-and may underrepresent current or potential therapeutic benefit. The lack of instruments to guide prescribers on harms/benefits weighing leaves a major clinical research gap.

Our protocol was registered online via the Open Science Framework at https://osf.io/3ckq6 .