Opioids are not much better at treating pain than a placebo

Opioids are only slightly more effective than placebos at treating pain, according to a new study.

For the study, researchers administered either real opioids or placebos to more than 26,000 people, all of whom were experiencing chronic, noncancer pain. The participants who took opioids reported "statistically significant but small improvements in pain and physical functioning, and increased risk of vomiting compared with placebo."

Given the slight benefits and major risks associated with opioids, the researchers found that other treatments, such as ice or physical therapy, might be better options for people suffering from chronic, noncancer pain.

"The effects of opioids on chronic pain are uncertain, whereas the harms found to be associated with prescription opioids include diversion, addiction, overdose, and death," the researchers wrote in their report, published in the Journal of the American Medical Association. "Compared with placebo, opioids were associated with increased vomiting, drowsiness, constipation, dizziness, nausea, dry mouth, and pruritus (itching)."

Most medical organizations and professionals support the prescription of opioids to treat cancer symptoms. But in recent decades doctors have increasingly prescribed these drugs to treat chronic pain stemming from a variety of ailments, including back pain, headaches and post-surgical pain.

Opioids might help to reduce pain for the estimated 50 million Americans who suffer from chronic pain, but the drugs also pose serious risks of overdose and addiction. That's why the Center for Disease Control and Prevention recommends that doctors only prescribe opioids to treat pain when absolutely necessary, and only after they've been made aware of alternative treatments.

"What most physicians do not recognize is that 92 percent of people who misuse opioids do so by taking prescription opioids, and that 75 percent of individuals who use heroin report that they started misusing opioids through the misuse of prescription opioids," the researchers wrote, suggesting that people in pain first try Tylenol, ibuprofen or naproxen, which are non-steroidal anti-inflammatory drugs.

Why do doctors still prescribe opioids to noncancer patients?

The answer is likely twofold. Patients might want a quick fix to end their pain, and painkillers represent a familiar solution. Meanwhile, doctors might have enough time or incentive to explore the many possible alternative treatment options with their patients, so they end up writing a prescription instead.

"There are many options to consider when offering treatment for chronic pain that go beyond pharmacological management such as physical therapy, cognitive behavioral therapy, mindful meditation, yoga, and tai chi," the scientists wrote. "However, explaining these options to patients can be difficult and time-consuming for clinicians and helping patients access these treatment options even more difficult."