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Are opioids safe and effective for chronic non-cancer pain? Summary of the evidence

opioid pain medication

It is oft said that opioids are not effective long term, and that chronic non-cancer pain should not be treated with opioids for this reason.  It is said that there is ‘no evidence that opioids work for pain long term’ and this lack of evidence is regarded as evidence.

But the fact is, there are no long-term studies. So its not that the evidence shows that opioids don’t work long term, its that there is NO evidence.  Period. The studies simply have not been done.

So using the phrase ‘there is no evidence opioids work long term’ is fallacious. It is purposefully obscuring the truth. 

The correct statement is we do not know if opioids work long term, because we don’t have any data. 

Except there is plenty of anecdotal data that for some patients, opioids are safe and effective and life-saving.  Yet chronic pain patients are currently being force tapered off their opioid pain relieving medications by doctors who are misguided, who believe the media rhetoric.

This is why I am putting together a repository of ‘evidence’. The best we have, to see what the science actually says about opioids for chronic non-cancer pain.  I have found, over and over, that when the media reports on a new study, the media headline rarely matches the study results. 

So here then, is the evidence on opioids for chronic non-cancer pain.  

2007 study: Long-term use of controlled-release oxycodone for noncancer pain results of a 3 year registry study

This study finds opioids effective for the majority of chronic non-cancer pain patients over three years with minimal dose increases and no serious adverse events, including addiction and overdose.

2012 study: Appropriate and responsible use of opioids in chronic non-cancer pain

2017 Study: “One Size Fits All” Doesn’t Fit When It Comes to Long-Term Opioid Use for People with Chronic Pain

This study found that “A significant subpopulation of people with chronic pain benefit from opioids with a reduction in pain and their access should be preserved “

December 2017 – Study: Are Prescription Opioids Driving the Opioid Crisis? Assumptions vs Facts

This study finds conclusively that the opioid epidemic is caused by illicit fentanyl and not prescription opioids for chronic pain. Further, it finds that the fear of opioid prescribing is based on assumptions and myth, not evidence. It concludes:

Many current assumptions about opioid analgesics are ill-founded. Illicit fentanyl and heroin, not opioid prescribing, now fuel the current opioid overdose epidemic. National discussion has often neglected the potentially devastating effects of uncontrolled chronic pain. Opioid analgesic prescribing and related overdoses are in decline, at great cost to patients with pain who have benefited or may benefit from, but cannot access, opioid analgesic therapy.

2018 Study: Efficacy of opioids versus placebo in chronic pain: a systematic review and meta-analysis of enriched enrollment randomized withdrawal trials

the study finds that opioids ARE effective for a period of 3 months or more. The study did not evaluate safety.

The studies conclusion: “

“This meta-analysis of FDA-required double-blind, randomized, placebo-controlled clinical trials of opioid analgesics for the treatment of chronic pain has shown that there is an ample evidence base supporting the efficacy of opioid analgesics for at least 3 months’ duration, a standard period for the evaluation of treatments for chronic pain and other chronic disorders.”

Author: PsychosomaticAddict

Chronic Pain Patient Advocate. Pain Coach. Patient. Living with High Impact Chronic Pain and advocating for proper pain treatment, including opioids where appropriate. Busting the myths. Exposing the actual science.

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