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Table 5. Adverse Effects Associated With Long-Term
Opioid Use
Persistent common adverse effects
Constipation
Mental clouding
Upper GI symptoms (pyrosis, nausea, bloating )
Endocrinopathy (hypogonadism/hyperprolactinemia)
Fatigue
Infertility
Osteoporosis/osteopenia
Reduced libido
Reduced frequency/duration or absence of menses
Neurotoxicity
Myoclonus
Other changes in mental status (including mood effects, memory problems, increased
risk of falls in the elderly)
Risk of opioid-induced hyperalgesia (incidence and phenomenolog y uncertain, but
escalating pain in tandem with dose escalation raises concern)
Sleep-disordered breathing
Increased risk of concurrent benzodiazepine in patients predisposed to sleep apnea
New-onset sleep apnea
Worsening of sleep apnea syndromes
Data adapted from: Dev R et al. Cancer 2014;120:1586-1593, Correa D et al. Anesth
Analg. 2015;120:1273-1285 & Lee M et al. Pain Physician 2011;14:145-161.
