Opioids vs. placebo, nonopioid alternatives for chronic noncancer pain

Bottom Line: An estimated 50 million adults in the United States were living with chronic noncancer pain in 2016 and many of them were prescribed opioid medications, even though a clinical benefit is uncertain. This study combined the results of 96 randomized clinical trials with about 26,000 participants to compare opioids with placebo and nonopioid alternative pain medications for the treatment of chronic noncancer pain. Opioids were associated with small improvements in pain and physical functioning plus increased risk of vomiting compared with placebo. Comparisons of opioids with nonopioid pain medication alternatives suggest the benefit for pain and functioning may be similar but the quality of evidence from the studies wasn't high. None of the studies provided rates of developing opioid use disorder.

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Authors: Jason W. Busse, D.C., Ph.D., McMaster University, Hamilton, Ontario, Canada, and coauthors

Related Material

The following related elements from the JAMA Network are also available on the For The Media website:

A summary video for this study is available to view on this page and to embed on your website by copying and pasting the HTML code below. To download the video, email mediarelations@jamanetwork.org">mediarelations@jamanetwork.org for information.

The JAMA editorial, "Increasing Evidence for the Limited Role of Opioids to Treat Chronic Noncancer Pain," by Michael A. Ashburn, M.D., M.P.H., and Lee A. Fleisher, M.D., of the University of Pennsylvania, Philadelphia.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jama.2018.18472)

Editor's Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.