Myth: Long-Term Opioid Therapy Is an Ineffective Treatment for Chronic Pain
The assumption that opioid therapy is not an effective treatment for chronic pain is simply not true. While some individuals with chronic pain do not experience pain relief from opioid therapy, many do. Therefore, the decision regarding whether to be treated with long-term opioid therapy should not be made based on the assumption that opioids are ineffective at reducing or relieving chronic pain.
The myth that opioid therapy is not an effective treatment for chronic pain may have been perpetuated from a randomized controlled trial that found opioids were not an effective option for chronic pain treatment. However, it was later suggested that this trial may have been flawed. For example, some study participants did not have severe enough pain to benefit from opioid therapy, while others did not have the medication properly titrated to an effective dosage to treat their pain.
However, other studies have shown opposite results. For example, during one study involving individuals with chronic low back pain, more than 70% of the study participants rated their experience taking oxymorphone as “good” or “excellent.” Another trial showed that transdermal fentanyl or continuous release oxycodone can provide sustained pain relief for years.
Another reason that opioids may be thought to be ineffective for chronic pain is that the dosage needed to relieve pain often varies widely from person to person. The precise reason for this difference is unknown, but it may be related to pain severity, genetic differences in opioid receptors, and differences in the way drugs are metabolized in the liver. Therefore, the notion that opioid treatment is ineffective may actually be the result of not receiving adequate doses of the medication.
Types of pain
Another factor that may contribute to the myth that opioids are not an effective treatment for chronic pain is that certain opioids may be more effective for some types of pain than others. For example, neuropathic pain responds better to certain opioids (e.g., methadone, levorphanol and tramadol) than to other opioids. If one opioid is ineffective in reducing or relieving chronic pain, a different one may be effective.
The bottom line
Before starting opioid therapy for chronic pain, individuals should have a discussion with their physician about treatment goals, potential benefits and risks, and a plan for dealing with medication side effects or discontinuing the medication if needed. If opioids are found to provide greater pain relief than non-opioid medications or non-medication treatment options and do not cause side effects, they are an effective treatment that can be used long-term under the guidance of a physician.
Additional resources used to create this article include Frontiers in Pain Research.