Analgesic efficacy of opioids in chronic pain: recent meta‐analyses

Reinecke, H; Weber, C; Lange, K; Simon, M; Stein, C; Sorgatz, H

doi:10.1111/bph.12634

Cited by 120Pain Management and Opioid UseOpioid Use Disorder TreatmentMusculoskeletal pain and rehabilitation

Analgesic efficacy of opioids in chronic pain: recent meta‐analyses

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Reinecke, H, Weber, C, Lange, K, Simon, M, Stein, C, Sorgatz, H·2015·British Journal of Pharmacology

DOI 10.1111/bph.12634PMC PMC4292950

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Abstract

Opioids are regularly administered in acute and cancer pain. In chronic non‐cancer pain (CNCP), however, their use is controversial. Previous meta‐analyses and randomized controlled trials (RCTs) lack methodological homogeneity and comparable data. Here we analysed the maximum analgesic efficacies of opioids and non‐opioids compared with placebo, and of physiotherapy and psychotherapy compared with active or waiting‐list controls. We screened 3647 citations and included RCTs if treatment duration was at least 3 weeks, data were sufficient for meta‐analysis, and criteria for high quality were met. Only 46 studies (10 742 patients) met the criteria. Weighted and standardized mean differences (WMD, SMD) between pain intensities were pooled to conduct separate meta‐analyses for each treatment category. At the end of treatment the WMD for pain reduction (100‐point scale) was 12.0 for ‘strong’ opioids, 10.6 for ‘weak’ opioids, 8.4 for non‐opioids (each vs. placebo), 5.5 for psychotherapy and 4.5 for physiotherapy (each vs. active controls). Dropout rates were high in pharmacological studies. The 95% confidence intervals using the outcomes of control groups did not indicate statistical differences between efficacies of the five interventions. Because not enough eligible head‐to‐head trials were available, our analysis is limited to adjusted indirect comparisons. The heterogeneity of pre‐post pain differences in control groups did not allow the definition of a common comparator. In conclusion, although there were statistically significant differences between maximum treatment efficacies, no intervention per se produced clinically important improvements in average pain intensity. Thus, opioids alone are inappropriate and multimodal treatment programmes may be required for CNCP. Linked Articles: This article is part of a themed section on Opioids: New Pathways to Functional Selectivity. To view the other articles in this section visit http://dx.doi.org/10.1111/bph.2015.172.issue-2

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Opioids are largely ineffective for chronic non-cancer pain and can even make pain worse.
“despite it being now clear that opioids are largely ineffective for chronic non-cancer pain 53 and can even make pain worse.”
From Tapering and withdrawing opioids: guidance informed by fundamental principles to minimise withdrawal symptoms (2025) · cites this paper as [53]

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Authors: Reinecke, H., Weber, C., Lange, K., Simon, M., Stein, C., & Sorgatz, H.
Affiliations: Technische Universität Darmstadt (DE)
Stiftung Charité (DE)
Corresponding author: Stein, C
ORCID: Reinecke, H
Stein, C
Venue: British Journal of Pharmacology
Publisher: Wiley
Published: 2014-07
Volume: 172
Issue: 2
Pages: 324-333
ISSN: 0007-1188 (ISSN-L)
1476-5381
DOI: 10.1111/bph.12634
PMC: PMC4292950
OpenAlex: W2135855727
Cited by: 120
References: 65
Citations by year: 2026: 5 · 2025: 8 · 2024: 13 · 2023: 7 · 2022: 11 · 2021: 16 · 2020: 18 · 2019: 7 · 2018: 11 · 2017: 9 · 2016: 6 · 2015: 6 · 2014: 3
FWCI: 1.61
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: British Journal of Pharmacology (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: Deutsche Forschungsgemeinschaft
Bundesministerium fuer Bildung und Forschung
Deutsche Gesellschaft zum Studium des Schmerzes
Topics: Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Keywords: opioids, chronic non-cancer pain, analgesic efficacy, strong opioids, weak opioids, non-opioid analgesics, physiotherapy, psychotherapy, multimodal pain management, pain intensity, placebo comparison, indirect comparison
MeSH terms: Analgesics, Humans, Quality of Life, Selection Bias, Treatment Outcome, Chronic Pain

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Analgesic efficacy of opioids in chronic pain: recent meta‐analyses

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