Opioids offer little chronic pain benefit, study says

Opioids offer minimal improvements over a placebo for adults with chronic pain, according to a recent analysis published in the Journal of the American Medical Association.

The meta-analysis includes 96 randomized clinical trials and 26,169 patients with chronic noncancer pain. The use of opioids was compared with placebo was associated with less pain (−0.69 cm on a 10-cm scale) and improved physical functioning (2.04 of 100 points), but the magnitude of the association was small, and the effects of opioids decreased over time. In addition, opioid use was significantly associated with increased risk of vomiting and could likely lead to physical dependence and overdose, researchers said.

The analysis also revealed that non-opioid alternatives, such as nonsteroidal anti-inflammatory drugs, certain antidepressants, and medical cannabis, showed similar improvements in pain and physical functioning. Researchers did not say whether opioid alternatives lost effectiveness over time.

"The benefits of opioids for managing chronic pain tend to be quite modest," said study author Jason Busse, PhD, associate professor in the department of anesthesia at McMaster University's school of medicine in Ontario, Canada.

This analysis follows national efforts to further regulate and reduce use of prescription opioids. In 2016, the U.S. Centers for Disease Control and Prevention (CDC) issued guidelines urging practitioners to prescribe opioids more responsibly. The new JAMA analysis considers more evidence than the CDC’s report, according to Busse, and therefore comes to less lenient conclusions.

The CDC describes chronic pain as "lasting longer than three months or past the time of normal tissue healing." It affected roughly 20 percent of adults, about 50 million people, in 2016, according to one report, though other estimates suggest that the number is twice that. It is one of the top reasons why people seek medical care in the U.S., according to the CDC.

This past June the National Institutes of Health (NIH) announced a comprehensive opioid addiction research plan, including nondrug and mind/body techniques such as yoga, tai chi, acupuncture, and mindfulness meditation to help patients control and manage pain.

Researchers say further analysis is needed to determine whether nonopioid alternatives can be an effective choice for pain patients, but they conclude opioids offer only small improvements, in addition to unpleasant side effects, and therefore should not be the first, second, or even third line of treatment. This paves the way for a myriad of opportunities, both for nondrug integrative therapies and non-opioid drug alternatives.