In short Article

Opioids for chronic pain: scarcely any added value

Anton J.F.A. Kerst. Hein J.E.M. Janssens
Nr 8|2019 (53)|Page 69-73|Main article|doi: 10.35351/gebu.2019.8.14|17-08-2019

Tags

Tags

The unmistakable increase in the number of prescriptions for opioids (with their associated risks of addiction and adverse effects) should be a subject for debate. There is, or at least appears to be, a firm belief in their effectiveness. Unfortunately, however, this effectiveness appears to be much lower when it comes to treating chronic (non-cancer-related) pain. The combined results of well-designed and conducted RCTs suggest that only about 12% of the patients included might derive some benefit from them, compared to placebo. No difference in terms of pain relief or improved quality of life has been found between opioids and drugs like NSAIDs. These findings should be an additional argument to stop prescribing opioids for chronic pain. And if care providers do prescribe them, they have a responsibility to ensure correct and minimised usage. This implies monitoring, no automatic repeat prescriptions and avoiding instructions like ‘1–6 tablets a day, as required’, especially for patients who are at risk of addiction. Guideline designers should also keep this in mind.
  • It is unlikely that opioids provide any relevant added value compared to placebo for the treatment of chronic (non-cancer-related) pain. 
  • There has been no research to prove that opioids offer any clinically relevant added value over other painkillers, such as NSAIDs, for the treatment of chronic pain.
  • Guidelines for the treatment of chronic pain should clearly state that there is little evidence for the effectiveness of opioids, and that there are risks of adverse effects and addiction.
  • There are enough arguments not to recommend opioids for most cases of chronic pain.
  • If opioids are prescribed for chronic pain anyway, the care providers involved have a responsibility with regard to informing their patients, ensuring correct usage and monitoring the effects.
  1. Leonardi C, Bagel J, Yamauchi P, Pariser D, Xu Z, Olesen M, Østerdal ML, Stein Gold L. Efficacy and Safety of Calcipotriene Plus Betamethasone Dipropionate Aerosol Foam in Patients With Psoriasis Vulgaris--a Randomized Phase III Study (PSO-FAST). J Drugs Dermatol. 2015 Dec;14(12):1468-77.
  2. Koo J, Tyring S, Werschler WP, Bruce S, Olesen M, Villumsen J, J Bagel J. Superior efficacy of calcipotriene and betamethasone dipropionate aerosol foam versus ointment in patients with psoriasis vulgaris – A randomized phase II study. J Dermatolog Treat, 2016; 27(2): 120–7.
  3. Paul C, Stein Gold L, Cambazard F, Kalb RE, Lowson D, Bang B, Griffiths CE. Calcipotriol plus betamethasone dipropionate aerosol foam provides superior efficacy vs. gel in patients with psoriasis vulgaris: randomized, controlled PSO-ABLE study. J Eur Acad Dermatol Venereol. 2017 Jan;31(1):119–126.
  4. College ter Beoordeling van Geneesmiddelen. Productinformatie Enstilar®. Via: www.geneesmiddeleninformatiebank.nl.
  5. College ter Beoordeling van Geneesmiddelen. Productinformatie Dovobet®. Via: www.geneesmiddeleninformatiebank.nl.
  6. Robinson A, Kardos M, Kimball AB. Physician Global Assessment (PGA) and Psoriasis Area and Severity Index (PASI): why do both? A systematic analysis of randomized controlled trials of biologic agents for moderate to severe plaque psoriasis. J Am Acad Dermatol. 2012 Mar;66(3):369-75.
  7. Michiels B. Relatief risico versus odds ratio. Minerva 2014; 13 (6): 77. Via: http://www.minerva-ebm.be/NL/Article/15.
  8. Mekkes JR. Finger Tip Unit (FTU). 2018 Via: https://www.huidziekten.nl/zakboek/dermatosen/ftxt/finger-tip-unit.htm
  9. Z-Index. G-Standaard. Via: KNMP-Kennisbank. KNMP, augustus 2019.
  10. Zorginstituut Nederland (GIPdatabank.nl). Aantal gebruikers -2017 van calcipotriol/betamethason.. Raming voor de totale Zvw-populatie 2017. Via: https://www.gipdatabank.nl/databank#/g//B_01-basis/gebr/D05AX
  11. Griffiths EMG, Stein Gold L, Cambazard F, Kalb RE, Lowson D, Møller A, et al. Greater improvement in quality of life outcomes in patients using fixed-combination calcipotriol plus betamethasone dipropionate aerosol foam versus gel: results from the PSO-ABLE study. Eur J Dermatol. 2018;28(3):356-63.
  12. Informatorium Medicamentorum. Den Haag: KNMP, 2019. Via: https://www.knmp.nl/producten/ knmp-kennisbank.
  13. Goodman&Gilman’s The pharmacological basis of therapeutics 13th edition. Brunton LL, Hilal-Dandan R, Knollmann BC. New York: Mc Graw Hill Medical, 2018.
  14. Van Peet PG, Spuls PhI, Ek JW, Lantinga H, Lecluse LLA, Oosting AJ, Visser HS, Burgers JS, Geijer RMM, Kolnaar BGM, Eizenga WH. NHG-Standaard Psoriasis(derde herziening). Huisarts Wet. 2014;57(3):128-35.

Authors

  • Anton J.F.A. Kerst. Hein J.E.M. Janssens