Strong opioids for noncancer pain due to musculoskeletal diseases: Not more effective than acetaminophen or NSAIDs.

Abstract

The classification of morphine as a step III analgesic, based on pharmacological data, creates a strong bias toward a belief in the efficacy of this drug. However, double-blind emergency-room trials showed similar levels of pain relief with intravenous acetaminophen as with intravenous morphine in patients with renal colic, low back pain or acute limb pain. In patients with chronic noncancer low back pain, morphine and other strong opioids in dosages of up to 100mg/day were only slightly more effective than their placebos, no more effective than acetaminophen, and somewhat less effective than nonsteroidal anti-inflammatory drugs (NSAIDs). In patients with osteoarthritis, strong opioids were not more effective than NSAIDs and, in some studies, than placebos. The only randomized controlled trial in patients with sciatica found no difference with the placebo. Chronic use of strong opioids can induce hyperalgesia in some patients. Hyperpathia with increased sensitivity to cold leading the patient to request higher dosages should suggest opioid-induced hyperalgesia. Pain specialists in the US have issued a petition asking that strong opioids be used in dosages no higher than 100mg/day of morphine-equivalent, in an effort to decrease the high rate of mortality due to the misuse and abuse of strong opioids (10,000 deaths/year in the US). Healthcare providers often overestimate the efficacy of step III analgesics, despite pain score decreases of only 0.8 to 1.2 points.

• Authors: Jean-Marie Berthelot, Christelle Darrieutort-Lafitte, Benoit Le Goff, Yves Maugars
• Journal: Joint bone spine (Joint Bone Spine) Vol. 82 Issue 6 Pg. 397-401 (Dec 2015) ISSN: 1778-7254 [Electronic] France
• PMID: 26453108 (Publication Type: Journal Article, Review)
• Copyright: Copyright © 2015 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

Chemical References

• Analgesics, Opioid
• Anti-Inflammatory Agents, Non-Steroidal
• Acetaminophen
• Morphine

Topics

• Acetaminophen (therapeutic use)
• Analgesics, Opioid (pharmacology, therapeutic use)
• Anti-Inflammatory Agents, Non-Steroidal (therapeutic use)
• Drug Tolerance
• Humans
• Morphine (pharmacology, therapeutic use)
• Musculoskeletal Pain (drug therapy, etiology)
• Time Factors
• Treatment Outcome