Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects
By Andrea Furlan, J. A. Sandoval, A. Mailis-Gagnon, E. Tunks. Canadian Medical Association Journal, 2006
869 citations recorded by the source corpus.
Background: Chronic noncancer pain (CNCP) is a major health problem, for which opioids provide one treatment option. However, evidence is needed about side effects, efficacy, and risk of misuse or addiction. Methods: This meta-analysis was carried out with these objectives: to compare the efficacy of opioids for CNCP with other drugs and placebo; to identify types of CNCP that respond better to opioids; and to determine the most common side effects of opioids. We searched MEDLINE, EMBASE, CENTRAL (up to May 2005) and reference lists for randomized controlled trials of any opioid administered by oral or transdermal routes or rectal suppositories for CNCP (defined as pain for longer than 6 mo). Extracted outcomes included pain, function or side effects. Methodological quality was assessed with the Jadad instrument; analyses were conducted with Revman 4.2.7. Results: Included were 41 randomized trials involving 6019 patients: 80% of the patients had nociceptive pain (osteoarthritis, rheumatoid arthritis or back pain); 12%, neuropathic pain (postherpetic neuralgia, diabetic neuropathy or phantom limb pain); 7%, fibromyalgia; and 1%, mixed pain. The methodological quality of 87% of the studies was high. The opioids studied were classified as weak (tramadol, propoxyphene, codeine) or strong (morphine, oxycodone). Average duration of treatment was 5 (range 1–16) weeks. Dropout rates averaged 33% in the opioid groups and 38% in the placebo groups. Opioids were more effective than placebo for both pain and functional outcomes in patients with nociceptive or neuropathic pain or fibromyalgia. Strong, but not weak, opioids were significantly superior to naproxen and nortriptyline, and only for pain relief. Among the side effects of opioids, only constipation and nausea were clinically and statistically significant. Interpretation: Weak and strong opioids outperformed placebo for pain and function in all types of CNCP. Other drugs produced better functional outcomes than opioids, whereas for pain relief they were outperformed only by strong opioids. Despite the relative shortness of the trials, more than one-third of the participants abandoned treatment.
Subfields: Anesthesiology and Pain Medicine, Physiology, Public Health, Environmental and Occupational Health
View Paper: https://www.semanticscholar.org/paper/e18d319c08cea0cfbf5bcd3cb40e198ffaaf9980
How researchers see this paper
The researchers whose trusted networks rank it highest, strongest advocate first. Every researcher gets a different order.
In Anesthesiology and Pain Medicine
In Public Health, Environmental and Occupational Health
Citations in the corpus
- The Effectiveness and Risks of Long-Term Opioid Therapy for Chronic Pain: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop (2015, background): “Compared with placebo, opioid therapy has been found to be associated with alleviation of pain in the short term (16, 17).”
- Evidence for Improving Palliative Care at the End of Life A Systematic Review (2008, background): “Our update identified reviews of the efficacy of opioids in noncancer pain (32) and local anesthetics for neuropathic pain (33).”
- Therapeutic opioids: a ten-year perspective on the complexities and complications of the escalating use, abuse, and nonmedical use of opioids. (2008, background): “Effectiveness of Opioid Treatment Multiple reviews have been published to evaluate the effectiveness of opioid therapy in chronic pain (6,7,32,62-65).”
- Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain (2009, neutral): “However, randomized trials that demonstrate the benefits of COT are most applicable to patients with moderate or more severe pain who have not responded to nonopioid therapies.(42,63) Presence of poorly-defined pain conditions,”
- Pharmacologic management of neuropathic pain: Evidence‐based recommendations (2007, neutral): “In evaluating the literature and developing recommendations, the Cochrane Database and other recent systematic reviews were emphasized [27,31,33,50,53,68,100,109,119,129].”
- Algorithm for neuropathic pain treatment: An evidence based proposal (2005, neutral): “In evaluating the literature and developing recommendations, the Cochrane Database and other recent systematic reviews were emphasized [27,31,33,50,53,68,100,109,119,129].”