Opioids Don't Really Do That Much for Chronic Pain, Meta-Analysis Finds

Not only do prescription opioid drugs come with a risk of addiction and overdose, but they also appear to provide little benefit for patients with chronic pain, according to a new study.



The study found that for people with chronic pain that's not caused by cancer, prescription opioid drugs were tied to only small improvements in pain, physical functioning and sleep quality, compared with a placebo.

What's more, prescription opioids were found to have similar pain-relief benefits as non-opioid treatments, such as nonsteroidal anti-inflammatory drugs (NSAIDS).

Given that prescription opioids are linked with serious risks, including addiction, overdose and death, and that other therapies may provide similar benefits, "our results support that opioids should not be first-line therapy for chronic noncancer pain," lead study author Jason Busse, an associate professor and researcher at McMaster University's Michael G. DeGroote Institute for Pain Research and Care, said in a statement.

The study was published today (Dec. 18) in the journal JAMA.[America's Opioid-Use Epidemic: 5 Startling Facts]

Though opioids have been widely prescribed to treat chronic pain, exactly how much patients benefit from these drugs, and whether the benefits outweigh the risks, has been unclear.

In the new study, a meta-analysis, the researchers analyzed information from 96 previous clinical trials of prescription opioids for chronic, noncancer pain; that included more than 26,000 people in total. In each trial, participants were given an opioid drug, a non-opioid treatment or a placebo. Participants were followed for at least one month.

The meta-analysis found that, compared with a placebo, 12 percent more patients treated with opioids experienced pain relief, 8 percent more had improvements in physical functioning and 6 percent more had improvements in sleep quality.

"These are very modest effects," Busse said. Opioids were not linked with improvements in social or emotional functioning, the study further found.

In addition, any benefits of opioid drugs waned over time, the results showed. But in real life, doctors often increase the dose of opioid drugs when patients don't experience pain relief, Dr. Michael Ashburn and Dr. Lee Fleisher, both of the University of Pennsylvania's Department of Anesthesiology and Critical Care, wrote in an editorial accompanying the study. "Given the clear risk of serious harm, opioids should not be continued without clear evidence” that they are working for a given patient, the editorial authors wrote.

The study also analyzed information from nine clinical trials involving more than 1,400 people that specifically compared opioid drugs with NSAIDs. Results showed that people who received opioid drugs reported about the same amount of pain relief as those who received NSAIDS, demonstrating, in other words, that NSAIDs appear to work just as well for pain relief.

In light of the opioid epidemic, doctors around the country have been making efforts to reduce prescriptions of the drugs. And these efforts may be working; in 2017, the number of people who misused prescription opioid drugs decreased by an estimated 400,000 and the number of people who started using heroin decreased by an estimated 89,000, compared with 2016, the editorial said.

However, 2017 was the deadliest year for opioid overdose deaths, according to the Centers for Disease Control and Prevention. Fentanyl, a powerful synthetic opioid, was largely responsible for the increase in deaths.

The editorial noted that opioids may still be a safe and effective treatment for carefully selected patients if those individuals are properly monitored over time. But "it is time for physicians to redouble efforts to improve the process of care when prescribing opioids," including diligently monitoring patients and avoiding overprescribing, the editorial concluded.

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