Opioid Treatments for Chronic Pain

In this systematic review, the Agency for Healthcare Research and Quality (AHRQ) assessed the effectiveness and harms of opioid therapy for chronic noncancer pain, alternative opioid dosing strategies, and risk mitigation strategies. This report updates and expands on a prior Comparative Effectiveness Review on long-term (1 year or more) effectiveness and harms of opioid therapy for chronic pain, including evidence on shorter-term (1 to 12 months) outcomes.

Researchers found that:

• At short-term follow-up, patients with chronic pain experienced small beneficial effects from opioid treatment versus placebo 
• However, opioids are associated with increased risk of short-term harms and don’t appear to be superior to nonopioid therapy
• Evidence on intermediate-term and long-term benefits remains very limited, and additional evidence confirms an association between opioids and increased risk of serious harms that appears to be dose-dependent

Further research is needed to:

• Develop accurate risk prediction instruments
• Determine effective risk mitigation strategies
• Clarify risks associated with co-prescribed medication
• Identify optimal opioid tapering strategies