Those benefits also tend to reduce over time and face the risk of side effects such as vomiting and constipation, according to the review of almost 100 random trials published in the Journal of the American Medical Association. According to the line, risks can include physical dependence and overdose.
"The advantages of opioids for chronic pain management tend to be quite moderate," said study author Jason Busse, a link teacher in the anesthesia department at the McMaster University medical school in Ontario, Canada.
The analysis comes as federal agencies and other officials in recent years have been catching down on the prescription of opioids, which is double recognized as an important tool in treating pain and as a gateway to physical dependence and captivity.
"We have looked at many additional evidence that has not been considered by the CDC guides," he said.
Dr. Jianguo Cheng, president of the Academy of American Pain Medicine, said the new analysis reinforces what constitutes conventional wisdom among pain experts. It was not part of the study.
"We're going to try the least dangerous drug first, so it's opioids [are] not the first line of treatment in most cases, "said Cheng, also director of the director of the Cleveland Clinical Multidisciplinary Pain Medicine Fellowship Program." It is not a second treatment, and may not be a third line of treatment. "
"There is a very complex and diverse population of patients," said Cheng, including those who may have suffered injuries, had multiple surgeries or living with a disability.
This is different from other types of pain, such as acute pain and cancer pain. For the latter, Cheng said, the use of opioids is much less controversial.
As most of these patients will not see meaningful improvements, however, do not ignore the sub-set that will prove them, says Busse.
"Problem interpretation of [the study findings] It would be: Opioids do not provide any meaningful pain binding, "he said." The challenge with that interpretation is to assume that every patient will have the same pain relief. "
His study estimates the amount of chronic pain patients that a doctor would need to treat in order for one to have meaningful improvements: For pain, there are around eight patients. For exercise, there are 12 patients. For sleeping quality, 17 patients.
And here's the "best case scenario," according to editorial published in the same journal by doctors with the Pennsylvania University Anesthesia and Critical Care Department.
The studies included in the analysis mainly put pressure on patients with past or present substance disorders, which Busse described as "the choice of patients who would be better ahead". Almost half of the studies also excluded patients who were diagnosed or treated for mental illness.
According to Cheng, alternative treatments that may be effective – such as physical and cognitive behavioral therapies – may be out of reach to many patients, in some cases because insurance does not repay these services.
However, despite gaps in information about chronic pain treatment, experts say that opioids are part of that array – even if they bring better risks and benefits.
"For individuals who suffer from incredible chronic pain daily from their lives, if they have tried other options that have not worked, they may in some cases decide that they are still want to start a test of [opioid] Therapy, "says Busse," and now they have the evidence to understand their chances of achieving meaningful improvement. "
Nadi Kounang contributed CNN to this report.[ad_2]