Cited by 873Pain Management and Opioid UseOpioid Use Disorder TreatmentMusculoskeletal pain and rehabilitation

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Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects

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Furlan, A. D.·2006·Canadian Medical Association Journal

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Abstract

BACKGROUND: Chronic noncancer pain (CNCP) is a major health problem, for which opioids provide one treatment option. However, evidence is needed about side effects, efficacy, and risk of misuse or addiction. METHODS: This meta-analysis was carried out with these objectives: to compare the efficacy of opioids for CNCP with other drugs and placebo; to identify types of CNCP that respond better to opioids; and to determine the most common side effects of opioids. We searched MEDLINE, EMBASE, CENTRAL (up to May 2005) and reference lists for randomized controlled trials of any opioid administered by oral or transdermal routes or rectal suppositories for CNCP (defined as pain for longer than 6 mo). Extracted outcomes included pain, function or side effects. Methodological quality was assessed with the Jadad instrument; analyses were conducted with Revman 4.2.7. RESULTS: Included were 41 randomized trials involving 6019 patients: 80% of the patients had nociceptive pain (osteoarthritis, rheumatoid arthritis or back pain); 12%, neuropathic pain (postherpetic neuralgia, diabetic neuropathy or phantom limb pain); 7%, fibromyalgia; and 1%, mixed pain. The methodological quality of 87% of the studies was high. The opioids studied were classified as weak (tramadol, propoxyphene, codeine) or strong (morphine, oxycodone). Average duration of treatment was 5 (range 1-16) weeks. Dropout rates averaged 33% in the opioid groups and 38% in the placebo groups. Opioids were more effective than placebo for both pain and functional outcomes in patients with nociceptive or neuropathic pain or fibromyalgia. Strong, but not weak, opioids were significantly superior to naproxen and nortriptyline, and only for pain relief. Among the side effects of opioids, only constipation and nausea were clinically and statistically significant. INTERPRETATION: Weak and strong opioids outperformed placebo for pain and function in all types of CNCP. Other drugs produced better functional outcomes than opioids, whereas for pain relief they were outperformed only by strong opioids. Despite the relative shortness of the trials, more than one-third of the participants abandoned treatment.

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Authors: Furlan, A. D.
Affiliations: Toronto Western Hospital (CA)
Corresponding author: Furlan, A. D.
ORCID: Furlan, A. D.
Venue: Canadian Medical Association Journal
Publisher: CMA Impact Inc.
Published: 2006-05-23
Volume: 174
Issue: 11
Pages: 1589-1594
ISSN: 0820-3946 (ISSN-L)
1488-2329
DOI: 10.1503/cmaj.051528
PMC: PMC1459894
OpenAlex: W2160172135
Cited by: 873
References: 52
Citations by year: 2026: 10 · 2025: 17 · 2024: 36 · 2023: 23 · 2022: 26 · 2021: 21 · 2020: 43 · 2019: 38 · 2018: 30 · 2017: 63 · 2016: 50 · 2015: 65 · 2014: 59 · 2013: 53 · 2012: 65
FWCI: 8.84
Type: journal article
Language: en
Open access: gold
doi.org
Locations: Canadian Medical Association Journal (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: University of Toronto
Canadian Institutes of Health Research
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 › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
Keywords: chronic non-cancer pain, opioids, opioid efficacy, opioid side effects, strong opioids, weak opioids, tramadol, morphine, oxycodone, constipation, nausea, fibromyalgia, neuropathic pain, nociceptive pain, back pain, osteoarthritis, rheumatoid arthritis, postherpetic neuralgia, treatment discontinuation
MeSH terms: Analgesics, Opioid, Chronic Disease, Humans, Pain, Pain Measurement, Placebos, Randomized Controlled Trials as Topic, Treatment Outcome

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Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects

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