Evidence Doesn’t Support Opioids for Chronic Pain

Evidence Doesn’t Support Opioids for Chronic PainAfter conducting a meta-review of medical databases, researchers have been unable to find solid evidence that supports the use of opioid painkillers for chronic pain. If these painkillers are truly helping people with chronic long-term pain, a case could be made that prescribing them is worth the accompanying risk of addiction. But the new study published in the Annals of Internal Medicine has cast doubt on the idea that these powerful narcotic drugs do what the companies selling them claim they do.

When physicians recommend a medication, it is reasonable to assume peer-reviewed research has verified its efficacy. But in the case of narcotic painkillers like OxyContin, Vicodin and Percocet, this assumption would be in error.

At least that is the claim of the joint Oregon Health & Science University/University of Washington research team responsible for a meta-review published in the pages of the Annals of Internal Medicine. After pouring over multiple English-language medical databases, they were unable to find a single example of a controlled, randomized study that evaluated the effectiveness of narcotic painkillers as a source of long-term pain relief (with long-term pain being defined as that which lasts for three months or more). There were a number of short-term studies lasting six weeks or less, but only a handful were carried on for longer periods and none provided useful information about the utility of these drugs for people suffering from chronic pain. The researchers looked for long-term studies that compared opioid painkillers to placebos, other types of medications and various forms of non-drug-based therapy, but could find nothing to prove these drugs were responsible for lasting pain relief, improved function or enhanced quality of life.

In the United States, more than 16,000 people die annually after overdosing on opioid painkillers. The members of this drug class are also among the most efficient substances on earth at creating addicts. Given these disturbing facts, it is seems clear they should be used only as a pain reliever of last resort—but this is not what has been happening.

Lack of Screening Tools

Part of the problem, as revealed by the Oregon Health & Science University/University of Washington meta-review, is that reliable screening tools for risk assessment are unavailable. Tools of this sort would allow physicians to determine which patients are more likely to abuse narcotic painkillers. So far, they have either not been developed or have not been studied enough to verify their accuracy.

At the present time, doctors are trying to balance the pain-relieving benefits of these drugs with their addictiveness by prescribing sustained-release, 24-hour versions that deliver medication in tiny, continuous doses. But there is no research that shows these drugs keep patients pain-free or protect them from the possibility of addiction. In general, data about the proper dosages of these medications for both pain management and the reduction of the risk of dependency is lacking to the point of non-existence. Somewhere between 5 million and 8 million Americans are taking opioid painkillers on a regular basis, and yet the doctors prescribing them don’t have evidence-based guidelines to rely on as they make decisions about when to distribute them and in what quantities.

Assessing the Dangers of Opioid Painkillers

While most of the publicity about this new meta-review is focusing on what the research team didn’t discover, what they did find is also significant. Studies don’t show the benefits of opioids for long-term pain sufferers, but they do reveal some of the hazards faced by those using these drugs on a continuous basis, including:

  • A dose-dependent relationship between opioid consumption and death by drug poisoning
  • A greater vulnerability to bone fractures
  • Troublesome cardiovascular side effects
  • Endocrine system malfunctions that may lead to erectile dysfunction or shortages of testosterone in men
  • A greater likelihood of becoming involved in an automobile accident, specifically at dosages above 20 mg/day

The researchers responsible for the study are not arguing that opioid painkillers are ineffective for long-term pain relief. What they are suggesting is that the medical profession’s steadfast reliance on these drugs for moderate-to-severe pain of any duration is premature and not backed by real evidence that demonstrates prescribing them is the best course of action. Long-term studies would help to alleviate some of the uncertainty, and just as importantly they would facilitate comparisons between opioid painkillers and alternative forms of pain relief, which might very well outperform the OxyContin, Percocet, Vicodin and other opioids.

In the meantime, it can only be hoped that as awareness continues to rise about the risks, physicians will proceed cautiously when prescribing these drugs and be open-minded enough to consider offering patients other options that might conceivably produce equal or even better results.

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