Scant Evidence for Opioids in Chronic Pain
Thursday, February 12, 2015 05:48 PM

There's no evidence for the long-term safety and efficacy of opioids in chronic pain -- a fact long touted by advocates who have called for tighter controls on opioids, now supported by a large-scale evidence review commissioned by federal agencies.

Most randomized, controlled trials of opioids for chronic pain were shorter than 6 weeks, and nearly all ran for no longer than 16 weeks, according to Roger Chou, MD, of Oregon Health and Science University, and colleagues.  And there is evidence of harm, including increased risks of overdose and abuse, the report commissioned by the Department of Health and Human Services noted.

"The lack of scientific evidence on effectiveness and harms of long-term opioid therapy for chronic pain is clear and is in striking contrast to its widespread use for this condition and the large increase in prescription opioid-related overdoses," Chou and colleagues wrote.

Panelist David Steffens, MD, MHS, of the University of Connecticut, and colleagues wrote in their report that a rising tide of both chronic pain and opioid overuse has "created a situation in which large numbers of Americans are receiving suboptimal care."

The root of the problem is a lack of knowledge about the best approaches to treating various types of pain and a dysfunctional healthcare delivery system that "promotes prescription of the easiest rather than the best approach to addressing pain," they wrote.

Behind that surge in opioid prescribing was a network of pain organizations, doctors, and researchers who pushed for expanded use of the drugs while taking millions of dollars from the companies that produced them.

Another controversy in the opioid space has been a Institute of Medicine report that estimated 100 million Americans live in chronic pain, particularly because experts who drafted the report had close ties to opioid drugmakers