Electrocardiographic and cardiovascular diagnostic characteristics of patients receiving long-term opioid therapy for pain

Jay W. Mason, MD; Ullrich S. Schwertschlag, MD, PhD; Vicki Klutzaritz, BS; Daniel M. Canafax, PharmD

doi:10.5055/jom.2014.0199

Authors

Jay W. Mason, MD
Ullrich S. Schwertschlag, MD, PhD
Vicki Klutzaritz, BS
Daniel M. Canafax, PharmD

DOI:

https://doi.org/10.5055/jom.2014.0199

Keywords:

opioids, electrocardiogram, myocardial infarction, arrhythmias, chronic pain

Abstract

Objective: To examine cardiovascular and electrocardiogram (ECG) abnormalities seen in patients with chronic pain receiving long-term opioid therapy and to compare them with findings in normal subjects.

Setting: Clinical pharmaceutical drug trial in a phase I pharmacology unit (normal subjects) and multiple phase 2b study sites (pain patients).

Patients: Four hundred sixty-one pain patients with constipation due to longterm opioid therapy who were screened for a clinical trial of an investigational treatment for opioid-induced constipation.

Interventions: None; all data used in this study were obtained prior to drug treatment.

Main outcome measures: This is a retrospective analysis of ECG abnormalities and clinical cardiovascular abnormalities in study participants compared with those in a normal reference group of 36,999 subjects.

Results: Numerical ECG values were modestly but not clinically significantly different in the pain patients requiring opioids (mean heart rate +1.5 BPM, PR +5.2 milliseconds, QRS - 4.7 milliseconds, and QT corrected for heart rate using the Fridericia formula +7.2 milliseconds). The largest difference in ECG diagnoses between the two groups was a fivefold greater incidence of previous myocardial infarction in the pain patient group (4.1 percent vs 0.8 percent). In addition, 50 percent of the pain patient group had a clinical cardiovascular diagnosis.

Conclusions: Patients with significant chronic pain requiring opioids have underlying clinical disorders that may be associated with abnormal cardiovascular physiology and ECGs. Clinicians who manage patients with chronic pain should be aware of the higher incidence of cardiovascular disease in this group.

Author Biographies

Jay W. Mason, MD

Professor of Medicine, Cardiology Division, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah

Ullrich S. Schwertschlag, MD, PhD

Formerly Consultant to Theravance, Inc., South San Francisco, California

Vicki Klutzaritz, BS

Theravance, Inc., South San Francisco, California

Daniel M. Canafax, PharmD

Theravance, Inc., South San Francisco, California

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