Evidence shows that opioids are not more effective than other analgesics for certain chronic pain conditions. Furthermore, evidence is mounting that the risks of opioid treatment, including opioid use disorder, overdose, and other previously under-recognized side effects (e.g., hyperalgesia, psychomotor impairment [which can increase the risk of fractures], myocardial infarction, sexual dysfunction) support the use of non-opioid therapy.
Thorough patient-centred discussion about risks, benefits, and expectations is essential.
Sources:
Busse JW, et al. Guideline for opioid therapy and chronic noncancer pain. CMAJ. 2017 May 8;189(18):E659-E666; PMID:28483845.
Busse JW, et al. Opioids for Chronic Noncancer Pain: A Systematic Review and Meta-analysis. JAMA. 2018 Dec 18;320(23):2448-2460. PMID:30561481.
Canadian Agency for Drugs and Technology in Health. Evidence Bundles: Alternatives to Opioids. [Internet]. [Accessed 20 Dec 2018].
Canada Agency for Drugs and Technology in Health. Opioids for the Treatment of Pain. [Internet]. September 2018. [Accessed 20 Dec 2018].
The Institute for Safe Medication Practices Canada. Opioid Pain Medicines Information for Patients and Families. [Internet]. March 2017. [Accessed 20 Dec 2018].
Krebs EE, et al. Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain: The SPACE Randomized Clinical Trial. JAMA. 2018 Mar 6;319(9):872-882. PMID:29509867.