Opioids for Chronic Pain: More Harm Than Help

With Americans' use of opioids increasing, a panel from the National Institutes of Health set out to measure the drugs' effectiveness in treating long-term chronic pain, and its report suggested that the risks outweigh the benefits.

With Americans’ use of opioids increasing, a panel from the National Institutes of Health (NIH) set out to measure the drugs’ effectiveness in treating long-term chronic pain, and its report suggested that the risks outweigh the benefits.

In 1991, opioid prescriptions totaled 76 million, but they have grown substantially since then, hitting the 219 million mark in 2011. As opioid use grows, so have opioid overdoses and interest in treatment for addiction to prescription painkillers.

The panel sought to find out whether the United States was using the best treatments with the fewest instances of harm, especially since there are alternative ways to treat chronic pain aside from opioids.

“At the root of the problem is the inadequate knowledge about the best approaches to treating various types of pain, which balance effectiveness with the potential for harm, as well as a dysfunctional health care delivery system that promotes prescription of the easiest rather than the best approach to addressing pain,” the report authors wrote.

For some patients, using opioids long-term may not relieve all pain, and quality of life may be diminished, the authors wrote. There are also little data to support the use of opioids for chronic pain, in general.

In addition, opioid-related deaths are drastically increasing. From 2000 to 2010, the number of individuals hospitalized for an addiction to prescription opioids increased more than 4-fold.

The panel also found that physicians receive little training on how to manage chronic pain among their patients. Additionally, health care professionals may have difficulty with identifying which patients are using opioids for the wrong reasons.

Once a physician decides to prescribe opioids, clinicians may also have trouble figuring out which opioid to use and at what dosage.

The study authors noted that the FDA has made some efforts to inform clinicians and pharmacists on switching between opioids by including data from drug trials in package inserts. However, they found that few pharmacists and clinicians are aware of this.

While noting that opioids are the right treatment for some patients, the NIH report suggested trying out a variety of treatments that incorporate non-pharmacologic options, such as physical therapy, and pharmacologic options, including non-opioid pharmacotherapies.

The NIH panel’s report also emphasized that the management of each patient’s chronic pain be individualized, and that a clinical assessment should be taken to examine any risk factors for the patient, such as a history of substance abuse.