+AA
Fr
Back
Evidence Summary

What is an Evidence Summary?

Key messages from scientific research that's ready to be acted on

Got It, Hide this
  • Rating:

In people with chronic noncancer pain, opioids reduce pain by a small amount

Busse JW, Wang L, Kamaleldin M, et al. Opioids for Chronic Noncancer Pain: A Systematic Review and Meta-analysis. JAMA. 2018;320:2448-60.

Review question

In people with chronic noncancer pain, do opioids relieve pain?

Background

Chronic (long-term) pain that is unrelated to cancer is common. It includes neuropathic pain (pain caused by damage to the nervous system), fibromyalgia, arthritis-related pain, and other types of noncancer pain.

Opioids are a class of pain-relieving drugs. They can also be dangerous because they are addictive, and by slowing breathing and heart rates, they can also cause death. This review looked at whether a specific class of drugs, opioids, can relieve chronic noncancer pain.

How the review was done

The researchers did a systematic review of studies available up to April 2018. They found 80 randomized controlled trials (RCTs) evaluating opioids. The RCTs included more than 20,000 people with an average age of about 58 years.

The key features of the RCTs were:

  • patients had osteoarthritis, rheumatoid arthritis, post-traumatic pain, post-traumatic neuralgia, painful diabetic neuropathy, postherpetic neuralgia, fibromyalgia, painful polyneuropathy, low back pain, phantom limb pain, chronic neck pain, or lumbar radiculopathy;
  • opioids included codeine, dihydrocodeine, fentanyl, hydrocodone, hydromorphone, meperidine, morphine, oxycodone, oxymorphone, tapentadol, and tramadol;
  • opioids were compared with placebo; and
  • people were followed for an average of 60 days.

 

What the researchers found

The evidence comparing opioids with placebo was of high quality.

Compared with placebo, opioids:

  • reduced pain severity by about 0.7 points out of a possible 10 points;
  • improved physical functioning by about 2 points out of a possible 100 points;
  • improved social functioning by about 1.6 points out of a possible 100 points;
  • improved sleep quality by about 3.4 points out of a possible 100 points;
  • did not improve emotional functioning; and
  • increased vomiting, constipation, drowsiness and other adverse events.

The improvements were very small and would not be noticeable by most people.

Conclusion

In people with chronic noncancer pain, opioids reduce pain by a small amount that would not be noticeable by most people.

Opioids vs placebo in people with chronic noncancer pain

Outcomes

Number of studies (and people)

Effect of opioids

Pain severity (after 3 to 6 months)

42 studies (16,617 people)

On a scale of 0 to 10, people reported a 0.7-point reduction in pain (could be as little as 0.6 and as many as 0.8 points).*

Physical functioning (after 1 to 6 months)

51 studies (15,574 people)

On a scale of 0 to 100, people’s physical functioning was about 2 points better (could be as little as 1.4 and as many as 2.7 points).*

Social functioning (after 1 to 4 months)

29 studies (7,623 people)

On a scale of 0 to 100, people’s social functioning was about 1.6 points better (could be as little as 0.5 or as many as 2.7 points).*

Sleep quality (after 3 to 6 months)

15 studies (6,585 people)

On a scale of 0 to 100, people slept about 3.4 points better (could be as little as 1.6 or as many as 5.3 points).*

Emotional functioning (after 1 to 4 months)

23 studies (8,962 people)

There was no evidence that people’s emotional functioning was better or worse with opioids.

Vomiting

33 studies (11,268 people)

About 7 more people out of 100 had vomiting (from as few as 5 to as many as 9 people).

*Although the opioid and placebo groups differed, the differences were not large enough for most individual patients to consider them important.



Related Topics


Glossary

Neuropathy
nerve pain
Placebo
A harmless, inactive, and simulated treatment.
Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

Related Web Resources

  • Several non-invasive treatments work for neck pain

    Institute for Work & Health
    Educational videos, exercise, and neck mobilization were more beneficial for treating neck pain or whip lash than ultrasound or electrical stimulation. Laser therapy, exercise and massage or acupuncture may help with chronic pain. Hard or soft collars did not work.
  • Headaches: Should I Take Medicine to Prevent Migraines?

    OHRI
    This patient decision aid helps people considering taking medicine every day to prevent migraines decide on whether or not to use preventive treatment by comparing the benefits, risks and side effects of both options.
  • Managing Pain From a Broken Hip: A Guide for Adults and Their Caregivers.

    OHRI
    This patient decision aid helps older adults (more than 50 years old) who is in a hospital because of a hip fracture decide on methods of managing pain. It outlines options such as using acetaminophen, opioid analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), and other treatments and compares the benefits and side effects associated with each option
DISCLAIMER These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (info@mcmasteroptimalaging.org).

Register for free access to all Professional content

Register
Want the latest in aging research? Sign up for our email alerts.
Subscribe
© 2012 - 2019 McMaster University | 1280 Main Street West | Hamilton, Ontario L8S4L8 | +1 905-525-9140 | Terms Of Use