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.
A Personal Note
I was so pleased to see this review. Unfortunately, when it comes to opioids, most people still don't understand that there is a big difference between physical dependence and addiction. (For more information read: Opioids: Addiction vs. Dependence) Hopefully this review will give us more ammunition in our fight for appropriate treatments for chronic pain patients.
Noble M, et al. Long-term opioid management for chronic noncancer pain (Review). Cochrane Database of Systematic Reviews. Issue 1, 2010.
McAdams, P. (2010, January 19). Used as Prescribed, opioids relieve chronic pain with little addiction risk. Health Behavior News Service.