A Royal Pain: Rx for Pain Lacked Research

Opioid therapy to treat chronic pain may not be healthy in the long term

(RxWiki News) So what’s the verdict on using opioids to treat pain? Opioids have effectively treated many patients with chronic pain — but not all of them. Bottom line: More research is needed on when to prescribe opioids.

The National Institutes of Health (NIH) recently released a position paper that noted some key gaps in opioid research. According to the NIH, these gaps have to be addressed so that doctors can better know when prescribing opioids is the right move.

A new study by the NIH found that there was not enough evidence to show that long-term opioid therapy for chronic pain actually helped in the long run. In fact, long-term use of opioids posed more risks than benefits in some cases — like the risk for overdose, abuse and fractures.

David B. Reuben, MD, of the University of California, Los Angeles, and a team of medical experts wrote the NIH position paper.

Dr. Reuben and team said there’s not enough research to guide “every clinical decision that a provider needs to make about the use of opioids for chronic pain, leaving the provider to rely on his or her own clinical experience.”

According to Dr. Reuben and team, some doctors relying on their own clinical experience may be prescribing opioids to patients when they're not necessary. And some patients who actually do need opioids may not be getting them.

The NIH advised doctors to follow guidelines given by professional societies and for hospitals to encourage this practice.

Supporting the position paper, the new NIH study found that there were risks in long-term use of opioids to treat chronic pain. Lead study author Roger Chou, MD, of the Oregon Health & Science University in Portland, and team reviewed 39 recent studies.

Like the position paper, this study found limited guidance on long-term opioid use. Dr. Chou and team also said there wasn’t enough evidence showing the effectiveness of long-term opioid therapy or that it helped in the long run.

In fact, Dr. Chou and team tied long-term opioids use to harm in some cases. The higher the opioid dose, the higher the risk of a patient overdosing or abusing opioids. Also, the higher the dose, the higher the risk of a patient getting bone fractures.

Opioids are a class of pain medications that includes such brand names as Vicodin, OxyContin and Avinza.

Dr. Reuben and his fellow position paper authors wrote that “Opioids are clearly the best treatment for some patients with chronic pain, but there are probably more effective approaches for many others. The challenge is to identify the conditions in patients for which opioid use is most appropriate, the optimal regimens, the alternatives for those who are unlikely to benefit from opioids, and the best approach to ensuring that every patient’s needs are met by a patient-centered health care system. For the more than 100 million Americans living with chronic pain, meeting this challenge cannot wait.”

Both the position paper and the study were published Jan. 12 in Annals of Internal Medicine.

The NIH funded the position paper. The US Department of Health and Human Services funded the study. Drs. Chou, Judith A. Turner, Ryan N. Hansen, Richard A. Deyo and Mr. Ian Blazina, Ms. Tracy Dana, and Ms. Christina Bougatsos received grants and personal fees from organizations like the Agency for Healthcare Research and Quality and the Mayday Foundation.

Review Date: 
January 11, 2015