Opioids Offer Small Improvement in Pain, Physical Function
TUESDAY, Dec. 18, 2018 -- Opioid use is associated with small improvements in pain and physical functioning in patients with chronic noncancer pain, according to research published in the Dec. 18 issue of the Journal of the American Medical Association.
Jason W. Busse, Ph.D., from McMaster University in Hamilton, Ontario, Canada, and colleagues conducted a systematic review of randomized clinical trials (RCTs) of opioids for chronic noncancer pain. Data were included for 96 RCTs with 26,169 participants.
The researchers found that opioid use correlated with reduced pain compared with placebo (weighted mean difference [WMD], −0.69 cm on a 10-cm visual analogue scale for pain), as well as improved physical functioning (WMD, 2.04 points on the 100-point Short Form physical component scale) and increased vomiting (5.9 versus 2.3 percent). Similar associations of opioids with improvements in pain and physical functioning were seen in comparison with nonsteroidal anti-inflammatory drugs (pain, WMD, −0.60 cm; physical functioning, WMD, −0.90 points); tricyclic antidepressants (pain, WMD, −0.13 cm; physical functioning, WMD, −5.31 points), and anticonvulsants (pain, WMD, −0.90 cm; physical functioning, WMD, 0.45 points) based on low- to moderate-quality physical evidence.
"[These findings] illustrate that most patients who are prescribed opioids for the treatment of chronic noncancer pain will not benefit from those drugs," write the authors of an accompanying editorial. "However, when opioids fail to provide pain relief, a common response by clinicians may be dose escalation rather than reconsidering use of the drug."
One author disclosed financial ties to Purdue Pharma.
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Posted: December 2018