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Opioids don't work well for chronic pain and are overused, study finds

“Compared with placebo, opioids were associated with small improvements in pain," the researchers found.

Opioids are not only overused and killing Americans in record numbers; they don’t even work that well for many types of pain, researchers found in a new study released Tuesday.

Oxycodone pills
Opioids are not only overused and killing Americans in records numbers; they don't even work that well for many types of pain, researchers found in a new study released Tuesday.Mark Lennihan / AP

Other drugs and treatments such as physical therapy or ice may work better for non-cancer pain, the researchers found. Yet when opioids fail to control pain, doctors often simply raise the dosage. This can help lead to a cycle of dependence and addiction.

The opioid epidemic continues to worsen despite years of warning an attention. Last year, 70,000 people died from drug overdoses, the Centers for Disease Control and Prevention reports. The majority of drugs involved were opioids such as fentanyl.

Opioids are most important for use in treating the pain associated with cancer, and medical groups all support their use for cancer pain. But they are often prescribed for back pain, headaches, post-surgical pain and other conditions.

Jason Busse of McMaster University in Ontario and colleagues went through much of the known research on how well opioids work.

“The effects of opioids on chronic pain are uncertain, whereas the harms found to be associated with prescription opioids include diversion, addiction, overdose, and death,” Busse and colleagues wrote in their report, published in the Journal of the American Medical Association.

“Compared with placebo, opioids were associated with small improvements in pain, physical functioning, and sleep quality; unimportant improvements in social functioning; and no improvements in emotional functioning or role functioning,” they wrote.

“Compared with placebo, opioids were associated with increased vomiting, drowsiness, constipation, dizziness, nausea, dry mouth, and pruritus (itching).”

Lots of Americans have pain, and opioids are a favored drug, the researchers noted.

“In 2016, an estimated 50 million adults in the United States were living with chronic noncancer pain, many of whom were prescribed opioid medications,” they wrote. “From 2013 to 2016, the United States was the largest per-capita consumer of opioids in the world.”

Their study supports what the CDC and other medical groups have been saying: that opioids don’t work well for many types of pain. The CDC has been trying to get doctors to prescribe opioids only when absolutely necessary, and to prescribe as low a dose as possible for the shortest time possible.

They recommend first trying Tylenol or drugs such as ibuprofen or naproxen, which are in a class called non-steroidal anti-inflammatory drugs, or NSAIDs. They also recommend trying low-tech options such as ice, physical therapy and massage. And, the CDC says, patients may have to change their expectations about living with pain.

“The findings reported by Busse (and colleagues) illustrate that most patients who are prescribed opioids for the treatment of chronic noncancer pain will not benefit from those drugs,” Dr. Michael Ashburn and Dr. Lee Fleisher of the University of Pennsylvania wrote in a commentary.

“However, when opioids fail to provide pain relief, a common response by clinicians may be dose escalation rather than reconsidering use of the drug.”

Doctors still do not realize that they are not always helping patients by offering an opioid, they noted.

“What most physicians do not recognize is that 92 percent of people who misuse opioids do so by taking prescription opioids, and that 75 percent of individuals who use heroin report that they started misusing opioids through the misuse of prescription opioids,” they wrote.

It is far quicker and easier to prescribe an opioid than to explain to a patient why they are not getting one, Ashburn and Fleisher said. That makes a doctor’s job harder. “There are many options to consider when offering treatment for chronic pain that go beyond pharmacological management such as physical therapy, cognitive behavioral therapy, mindful meditation, yoga, and tai chi,” they wrote.

“However, explaining these options to patients can be difficult and time-consuming for clinicians and helping patients access these treatment options even more difficult.”