Review Shows Opioids Relieve Chronic Pain with Little Addiction Risk
A new review supports what those of us who have worked in the area of chronic pain have long known – people who take opioids for real chronic pain problems rarely become addicted to them.
Meredith Noble, a senior research analyst at ECRI Institute, one of 14 evidence-based Practice Centers in the country under the U.S. Agency for Healthcare Research and Quality, and her colleagues reviewed the findings of 26 clinical studies comprising 4,893 participants. “There is a lack of consensus that opioids are safe and effective for people with chronic severe non-cancer pain,” Noble said. “We wanted to look at studies that treated people for six months or longer, given that chronic pain can go on for years. This review includes studies of individuals on opioids for as long as 48 months.”
Patients in the studies had previously tried other treatments like non-opioid medications and physical therapy, but still had considerable pain. Clinicians prescribed opioids including oxycodone, morphine and methadone by pill, transdermal (skin) patch or intrathecal pump. Most of the patients in this review had chronic back pain following failed surgery, severe osteoarthritis, or pain related to nerve damage.
Among studies reporting abuse or addiction, only seven of 2,613 participants reportedly took their medicine inappropriately or became addicted. That's only about one quarter of one percent. The findings indicate that carefully selected patients with no history of addiction and abuse, who take their medications as prescribed, can experience good amounts of pain relief with a very small risk of addition.
Alex DeLuca, M.D., an independent consultant specializing in addiction and pain medicine, praised the thoroughness of this review and pointed out the very low rate of signs of addiction in treated pain patients. A take-home message for physicians reading this review is that all relevant studies find that long-term opioid therapy improves the life of non-cancer patients experiencing chronic pain and is both safe and effective, DeLuca said, and there is zero evidence to the contrary.
I thankfully have a doc who told me this when she first put me on opioid drugs I know I'm physiogically dependant and that is bad enough. But true pain your just happy to get something that will relieve it!
Thanks Red, I've been trying to tell my family this for years...My Mother knows though. She takes two percocets a day, one in the morning and one in the evening. She feels it if she misses a dose but is not addicted. Others who don't go through this journey have no clue.
I do know of ppl that have become addicted and it's sad.
For those not aware of the Cochrane Database, it is a database of medical review articles on specific topics, such as chronic pain treatment, for instance. A review article is a review of existing scientific literature on the topic under review. The article that Red931 is referring to may be found here:
Please be careful not to over-reach on interpretation of the conclusions when reading these sorts of articles. For example, this particular article is good news in so far as addiction risk goes, but they do not consider that the evidence for opioids giving good long term relief is particularly strong, when looking at the statistical evidence available from the articles they included in their review. Obviously at the individual level many people here can attest to good pain relief from opioids once that most suitable one(s) are found and titrated to the best dose. Some individuals don't get any/sufficient relief from opioids and discontinue use pretty quickly once they realise that.
Personally, I've thought for some time that the risk of addiction to a pain-suppression medication should be treated in exactly the same way as any other adverse side-effect risk. Make sure that the patient is aware of the risk, the potential consequences, and the options available should it eventuate. For one, patients who have trouble with one narcotic or opioid may find another is quite okay. Even something as simple as switching from oral doses to transdermal dosing might be enough. Unfortunately both in my country of Australia and the USA there is a fear of the law enforcement offices by doctors. In my place of residence the Drug and Alcohol guys are now in charge of opiate regulations and enforcement, having taking it over from the state governments medical health agency. Naturally doctors are more reluctant to risk prescribing opioids. Bummer.
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