Chronic pain medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Medical Therapy
Opioids are effective for short term use (1-16 weeks)[1].
For chronic, non-cancer pain, opioids may give short term reduction in pain compared to placebo.[2][3][4] The role of long term treatment of chronic non-cancer pain is not clear and a systematic review by the Cochrane Collaboration found "weak evidence suggests that patients who are able to continue opioids long-term experience clinically significant pain relief. Whether quality of life or functioning improves is inconclusive."[5]
One systematic review found that trials of short term opioids did not improve functional status compared to placebo in chronic pain.[2] However, a second systematic review, found that opioids improved functional status compared to placebo, but not compared to other drugs.[4]
As example randomized controlled trials, opioids reduced pain in the short term, but did not improve function in comparison to an cholinergic antagonist placebo[6] or tricyclic antidepressant.[7]
Most trials are funded by industry.[4]
References
- ↑ Chou R, Huffman LH, American Pain Society. American College of Physicians (2007). "Medications for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline". Ann Intern Med. 147 (7): 505–14. PMID 17909211. Review in: Evid Based Nurs. 2008 Apr;11(2):50
- ↑ 2.0 2.1 Kalso E, Edwards JE, Moore RA, McQuay HJ (2004). "Opioids in chronic non-cancer pain: systematic review of efficacy and safety". Pain. 112 (3): 372–80. doi:10.1016/j.pain.2004.09.019. PMID 15561393.
- ↑ Martell BA, O'Connor PG, Kerns RD, Becker WC, Morales KH, Kosten TR; et al. (2007). "Systematic review: opioid treatment for chronic back pain: prevalence, efficacy, and association with addiction". Ann Intern Med. 146 (2): 116–27. PMID 17227935.
- ↑ 4.0 4.1 4.2 Furlan AD, Sandoval JA, Mailis-Gagnon A, Tunks E (2006). "Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects". CMAJ. 174 (11): 1589–94. doi:10.1503/cmaj.051528. PMID 16717269.
- ↑ Noble M, Treadwell JR, Tregear SJ, Coates VH, Wiffen PJ, Akafomo C; et al. (2010). "Long-term opioid management for chronic noncancer pain". Cochrane Database Syst Rev (1): CD006605. doi:10.1002/14651858.CD006605.pub2. PMID 20091598.
- ↑ Moulin DE, Iezzi A, Amireh R, Sharpe WK, Boyd D, Merskey H (1996). "Randomised trial of oral morphine for chronic non-cancer pain". Lancet. 347 (8995): 143–7. PMID 8544547.
- ↑ Raja SN, Haythornthwaite JA, Pappagallo M, Clark MR, Travison TG, Sabeen S; et al. (2002). "Opioids versus antidepressants in postherpetic neuralgia: a randomized, placebo-controlled trial". Neurology. 59 (7): 1015–21. PMID 12370455. Review in: J Fam Pract. 2003 Jul;52(7):517-8