Opioids May Help Chronic Pain, But Not Much

HealthDay Reporter

TUESDAY, Dec. 18, 2018 (HealthDay News) — Potentially addictive opioid painkillers are often prescribed for chronic pain , but they actually work only slightly better than placebo pills, a new review shows.

The analysis, of 96 clinical trials , found that on average, opioids made only a small difference for people with conditions like osteoarthritis , fibromyalgia and sciatica .

And the modest pain relief sometimes came at a cost of side effects like nausea , vomiting, constipation and drowsiness.

The researchers said the findings add to evidence that for most people with chronic pain, opioids should be a last resort, if they’re prescribed at all.

"Opioids should not be a first-line therapy for chronic, non-cancer pain," said lead researcher Jason Busse, of the Institute for Pain Research and Care at McMaster University, in Canada.

Dr. Michael Ashburn, a pain medicine specialist at the University of Pennsylvania, in Philadelphia, agreed.

"This is confirmation of the limited role opioids play in treating chronic, non-cancer pain," Ashburn said.

Most of the daily news on opioids centers on the national epidemic of abuse and addiction — to prescription opioids and illegal forms like heroin .

But Ashburn stressed that the risks go beyond addiction : Patients can suffer side effects even when they diligently take their medication as directed.

"Opioids really only provide modest longer-term effects," he said. "And taking them for longer periods significantly increases the risk of harm."

Ashburn co-wrote an editorial published with the review findings in the Dec. 18 issue of the Journal of the American Medical Association .

There are already medical guidelines — from the U.S. Centers for Disease Control and Prevention and other groups — that discourage doctors from prescribing opioids for most cases of chronic pain.

The new findings support those recommendations, Busse said.

Prescription opioids include drugs like Vicodin , OxyContin, codeine and morphine . They are powerful analgesics, Busse noted — and they can ease cancer -related pain or severe short-term pain after surgery or an injury.

"But chronic, non-cancer pain seems to be different," Busse said.

Across the trials his team analyzed, opioids worked better than placebo pills — but not by much. Overall, Busse said, 12 percent more patients saw a "noticeable" difference in their pain after starting opioids, versus placebo pills.

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