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Efficacy and safety of strong opioids for chronic noncancer pain and chronic low back pain: a systematic review and meta-analyses

Nury, Edris, Schmucker, Christine, Nagavci, Blin, Motschall, Edith, Nitschke, Kai, Schulte, Erika, Wegwarth, Odette, Meerpohl, Joerg J.·2022·Pain
DOI 10.1097/j.pain.0000000000002423
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Abstract

In recent years, long-term prescribing and use of strong opioids for chronic noncancer pain (CNCP) has increased in high-income countries. Yet existing uncertainties, controversies, and differing recommendations make the rationale for prolonged opioid use in CNCP unclear. This systematic review and meta-analyses compared the efficacy, safety, and tolerability of strong opioids with placebo or nonopioid therapy in CNCP, with a special focus on chronic low back pain (CLBP). Systematic literature searches were performed in 4 electronic databases (MEDLINE, Web of Science, Cochrane Library, and CINAHL) in July 2019 and updated by regular alerts until December 2020. We included 16 placebo-controlled randomized controlled trials for CLBP and 5 studies (2 randomized controlled trials and 3 nonrandomized studies) of opioids vs nonopioids for CNCP in the quantitative and qualitative synthesis. Random effects pairwise meta-analyses were performed for efficacy, safety, and tolerability outcomes and subgroup analyses for treatment duration, study design, and opioid experience status. Very low to low certainty findings suggest that 4 to 15 weeks (short or intermediate term) opioid therapy in CLBP (compared with placebo) may cause clinically relevant reductions in pain but also more gastrointestinal and nervous system adverse events, with likely no effect on disability. By contrast, long-term opioid therapy (≥6 months) in CNCP may not be superior to nonopioids in improving pain or disabilit…

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Metadata

Authors
Nury, E., Schmucker, C., Nagavci, B., Motschall, E., Nitschke, K., Schulte, E., Wegwarth, O., & Meerpohl, J. J.
Affiliations
  • University of Freiburg (DE)
  • Humboldt-Universität zu Berlin (DE)
Corresponding author
Nury, Edris
ORCID
Venue
Pain
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2021-07-28
Volume
163
Issue
4
Pages
610-636
ISSN
  • 0304-3959 (ISSN-L)
  • 1872-6623
DOI
10.1097/j.pain.0000000000002423
OpenAlex
W3183765240
Cited by
85
References
15
Citations by year
2026: 16 · 2025: 18 · 2024: 20 · 2023: 15 · 2022: 13 · 2021: 3
FWCI
2.27
Type
journal article
Language
en
Open access
closed
Locations
  • Pain (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
  • Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
Keywords
strong opioids, chronic non-cancer pain, chronic low back pain, long-term opioid therapy, opioid efficacy, opioid safety, gastrointestinal adverse effects, opioid use disorder, opioid abuse, disability, all-cause mortality, non-opioid analgesics
MeSH terms
Analgesics, Opioid, Humans, Opioid-Related Disorders, Research Design, Low Back Pain, Analgesics, Non-Narcotic, Chronic Pain

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Nury, E., Schmucker, C., Nagavci, B., Motschall, E., Nitschke, K., Schulte, E., Wegwarth, O., & Meerpohl, J. J. (2022). Efficacy and safety of strong opioids for chronic noncancer pain and chronic low back pain: a systematic review and meta-analyses. Pain. https://doi.org/10.1097/j.pain.0000000000002423