In short Article

Opioids for chronic pain: scarcely any added value


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 derived 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.

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Authors

  • dr AJFA Kerst, dr HJEM Janssens