The DOI matches its Crossref record; 109 of the 110 references it cites were found in a registry or an index.
Effectiveness of Opioids in the Treatment of Chronic Non-Cancer Pain
Open accessAbstract
For thousands of years, opioids have been used to treat pain, and they continue to be one of the most commonly prescribed medications for pain. It is estimated that 90% of patients presenting to pain centers and receiving treatment in such facilities are on opioids. Opioids can be considered broad-spectrum analgesics that act at multiple points along the pain pathway. Unfortunately, opioids also have the potential for great harm, with multiple side effects and potential complications, some of which are lethal. They are also uniquely addictive, which can lead to misuse and diversion. We reviewed the relevant English literature and did thorough manual searches of the bibliographies of known primary and review articles. We utilized pain relief as the primary outcome measure. Other outcome measures were functional improvement, improvement of psychological status, improvement in work status, and evidence of addiction. Short-term use and improvement was defined as less than 6 months and long-term relief was defined as 6 months or longer. The 3 systematic reviews evaluating long-term effectiveness of opioids for chronic non-cancer pain provided unclear and weak evidence. The results of this review showed that many patients in the included studies were dissatisfied with adverse events or insufficient pain relief from opioids and withdrew from the studies. For patients able to continue on opioids, evidence was weak suggesting that their pain scores were lower than before therapy and that this relief could be maintained long-term (> 6 months). There was also weak evidence that long-term opioid therapy with morphine and transdermal fentanyl not only decreases pain but also improves functioning. Limited evidence was available for the most commonly used opioids, oxycodone and hydrocodone. Evidence for the ability to drive on chronic opioid therapy was moderate without major side effects or complications. It is concluded that, for long-term opioid therapy of 6 months or longer in managing chronic non-cancer pain, with improvement in function and reduction in pain, there is weak evidence for morphine and transdermal fentanyl. However, there is limited or lack of evidence for all other controlled substances, including the most commonly used drugs, oxycodone and hydrocodone.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“The list of adverse symptoms included the most frequent side effects of treatments for pain [52,57,58].”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
Part of this paper’s reference list could not be split into single entries.
Centers for Disease Control and Prevention
Branum, A. (2007) · Sage eBooks · doi:10.4135/9781412952644.n74 · Cited by 6,434
Anaesthesia, surgery, and challenges in postoperative recovery
Kehlet, H., & Dahl, J. B. (2003) · The Lancet · doi:10.1016/s0140-6736(03)14966-5 · Cited by 1,449
Opioids in chronic non-cancer pain: systematic review of efficacy and safety
Kalso, E., Edwards, J. E., Moore, A. R., & McQuay, H. J. (2004) · Pain · doi:10.1016/j.pain.2004.09.019 · Cited by 1,216
Morphine, Gabapentin, or Their Combination for Neuropathic Pain
Gilron, I., Bailey, J. M., Tu, D., Holden, R. R., Weaver, D. F., & Houlden, R. L. (2005) · New England Journal of Medicine · doi:10.1056/nejmoa042580 · Cited by 1,080
Opioid Therapy for Chronic Pain
Ballantyne, J. C., & Mao, J. (2003) · New England Journal of Medicine · doi:10.1056/nejmra025411 · Cited by 960
Chronic use of opioid analgesics in non-malignant pain: Report of 38 cases
Portenoy, R. K., & Foley, K. M. (1986) · Pain · doi:10.1016/0304-3959(86)90091-6 · Cited by 894
Opioids for chronic noncancer pain: A meta-analysis of effectiveness and side effects
Furlan, A. D. (2006) · Canadian Medical Association Journal · doi:10.1503/cmaj.051528 · Cited by 873
Martell, B. A., O’Connor, P. G., Kerns, R. D., Becker, W. C., Morales, K. H., Kosten, T. R., & Fiellin, D. A. (2007) · Annals of Internal Medicine · doi:10.7326/0003-4819-146-2-200701160-00006 · Cited by 773
Increasing deaths from opioid analgesics in the United States
Paulozzi, L. J., Budnitz, D. S., & Xi, Y. (2006) · Pharmacoepidemiology and Drug Safety · doi:10.1002/pds.1276 · Cited by 696
Manchikanti, L. (2008) · Pain Physician · doi:10.36076/ppj.2008/11/s63 · Cited by 638
Research works printed but not linked: 12
- Carr DB, Goudas LC. Acute pain. Lancet 1999; 353:2051-2058.
- Manchikanti L, Pampati V, Damron KS, Beyer CD, Barnhill RC, Fellows B. Prev- alence of prescription drug abuse and dependency in patients with chronic An evaluation of multiple variables. Pain Physician 2006; 9:215-226.
- Deyo RA, Bass JE, Walsh NE, Schoenfeld LS, Ramamurthy S. Prognostic variabil- ity among chronic pain patients: Impli- cations for study design, interpreta- tion, and reporting. Arch Phys Med Re- habil 1988; 69:174-178.
- Mahmud MA, Webster BS, Courtney TK, pain in western Kentucky. J KY Med As- soc 2003; 101:511-517.
- Manchikanti L, Pampati V, Damron KS, Beyer CD, Barnhill RC. Prevalence of il- licit drug use in patients without con- trolled substance abuse in interven- tional pain management. Pain Physi- cian 2003; 6:173-178.
- Vaglienti RM, Huber SJ, Noel KR, John- stone RE. Misuse of prescribed con- trolled substances defined by urinaly- sis. W V Med J 2003; 99:67-70.
- Bouckoms A, Masand P, Murray G, Cas- sem E, Stern T, Tesar G. Chronic nonma- lignant pain treatment with long-term analgesics. Ann Clin Psychiatry 1992; 4:185-192.
- Deshpande A, Furlan A, Mailis-Gagnon A, Atlas S, Turk D. Opioids for chronic low back pain (review). Cochrane Data- base Syst Rev 2007; 3:CD004959.
- Sandoval JA, Furlan AD, Mailis-Gagnon AM. Oral methadone for chronic non- cancer pain; A systemic literature re- view of reasons for administration, pre- scription patterns, effectiveness, and side effects. Clin J Pain 2005; 21:503- 512.
- Mercadante S. Opioid rotation for can- cer pain: Rationale and clinical aspects. Cancer 1999; 86:1856-1866.
- Harden RN. Chronic opioid therapy: An- other reappraisal. APS Bulletin 2002; 12:1,8-12.
- Maier C, Schaub C, Willweber-Strumpf A, Zenz M. Long-term efficacy of opi- oid medication in patients with chronic non-cancer-associated pain. Results of a survey 5 years after onset of medical treatment. Schmerz 2005; 19:410-417.
Cited by
Sorted by citations
Items 101–168 of 168
Day, M. A., Ciol, M. A., Mendoza, M. E., Borckardt, J. J., Ehde, D. M., Newman, A. K., Chan, J. F., Drever, S. A., Friedly, J. L., Burns, J. W., et al. (2024) · BMC Medicine · doi:10.1186/s12916-024-03383-2 · Cited by 15
Yoshida, K., Sekiguchi, M., Otani, K., Mashiko, H., Shioda, H., Wakita, T., Niwa, S., Kikuchi, S., & Konno, S. (2015) · Journal of Orthopaedic Science · doi:10.1007/s00776-015-0694-8 · Cited by 11
Literature Review of Research on Chronic Pain and Yoga in Military Populations
Miller, S., Gaylord, S. A., Buben, A., Brintz, C., Olmsted, K. R., Asefnia, N., & Bartoszek, M. W. (2017) · Medicines · doi:10.3390/medicines4030064 · Cited by 10
Carrillo, M., Yingst, J. M., Tuan, W., Giampetro, D. M., Nyland, J. E., & Zgierska, A. E. (2025) · Pain Management · doi:10.1080/17581869.2025.2463865 · Cited by 10
Schellekens, A., Veldman, S. E., Suranto, E. S. D., van Rijswijk, S. M., van der Wal, S. E. I., Schene, A. H., & Beek, M. H. C. T. V. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10163727 · Cited by 9
Opioids and Risk of Type 2 Diabetes in Adults with Non-Cancer Pain
Jick, S. S. (2013) · Pain Physician · doi:10.36076/ppj.2013/16/77 · Cited by 9
Catalá, E., Ferrándiz, M., Lorente, L., Landaluce, Z., & Genové, M. (2011) · Revista Española de Anestesiología y Reanimación · doi:10.1016/s0034-9356(11)70063-9 · Cited by 8
Gatti, A., Mammucari, M., Sabato, E., Masucci, L., & Sabato, A. F. (2011) · Advances in Therapy · doi:10.1007/s12325-011-0020-6 · Cited by 8
Okusaga, O., Mowat, R. M., & Cook, C. M. (2022) · Australian journal of advanced nursing · doi:10.37464/2020.392.410 · Cited by 8
Hansen, J. L., Heilig, M. A., Kalso, E. A., Stubhaug, A., Knutsson, D., Sandin, P., Dorling, P., Beck, C., Grip, E. T., Blakeman, K. H., et al. (2023) · Scandinavian Journal of Pain · doi:10.1515/sjpain-2022-0137 · Cited by 8
Díaz-Ruano, S., López-Pérez, A. E., Girón, R., Pérez-García, I., Martı́n, M. I., & Abalo, R. (2019) · Journal of Neurogastroenterology and Motility · doi:10.5056/jnm18202 · Cited by 7
Opioid Treatment Agreements Are the Answer. What Is the Question?
Anderson, E. D., & Burris, S. C. (2010) · The American Journal of Bioethics · doi:10.1080/15265161.2010.520583 · Cited by 6
Rau, J., Hemphill, A., Araguz, K., Cunningham, R., Stefanov, A., Weise, L., & Hook, M. A. (2022) · Journal of Neurotrauma · doi:10.1089/neu.2022.0208 · Cited by 6
Zhang, Z., Hu, B., Li, J., Yang, H., Liu, L., Song, Y., & Yang, X. (2023) · Orthopaedic Surgery · doi:10.1111/os.13644 · Cited by 6
A review of opioid prescription in a teaching hospital in Colombia
Moyano, J., & Figueras, A. (2012) · Journal of Pain Research · doi:10.2147/jpr.s32603 · Cited by 6
Systemic opioid and chronic pain
Varrassi, G., Angeletti, C., Guetti, C., Marinangeli, F., & Paladini, A. (2009) · European Journal of Pain Supplements · doi:10.1016/j.eujps.2009.08.001 · Cited by 6
Verloo, H., Cohen, C., Borloz, C., Kabengele, E. M., & Chastonay, P. (2013) · Nursing Research and Reviews · doi:10.2147/nrr.s39401 · Cited by 6
Utilizing Nature as a Source of New Probes for Opioid Pharmacology
Lovell, K. M., Simpson, D. S., Cunningham, C. W., & Prisinzano, T. E. (2009) · Future Medicinal Chemistry · doi:10.4155/fmc.09.22 · Cited by 6
Einer neuen Wahrheit ist nichts schädlicher als ein alter Irrtum
Sorgatz, H., & Maier, C. (2010) · Der Schmerz · doi:10.1007/s00482-010-0946-7 · Cited by 6
Davis, M. P. (2016) · Expert Opinion on Drug Metabolism & Toxicology · doi:10.1080/17425255.2016.1191469 · Cited by 5
Conventional Practice for Medical Conditions for Chronic Opioid Therapy
Smith, H. S. (2012) · Pain Physician · doi:10.36076/ppj.2012/15/es1 · Cited by 5
Sublingual Buprenorphine/Naloxone and Multi-Modal Management for High-Risk Chronic Pain Patients
Kaski, S. W., Marshalek, P. J., Herschler, J., Wen, S., & Zheng, W. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10050973 · Cited by 5
Glucosides of morphine derivatives: synthesis and characterization
Váradi, A., Lévai, D., Tóth, G., Horváth, P., Noszál, B., & Hosztafi, S. (2012) · Monatshefte für Chemie - Chemical Monthly · doi:10.1007/s00706-012-0868-4 · Cited by 5
The Pharmacists’ Role in Patient–Provider Pain Management Treatment Agreements
Craig, D. S. (2012) · Journal of Pharmacy Practice · doi:10.1177/0897190012453909 · Cited by 5
Using implementation science to decrease variation and high opioid administration in a surgical ICU
Kalkwarf, K. J., Bailey, B. J., Wells, A. A., Jenkins, A. K., Smith, R. R., Greer, J. W., Yeager, R., Bruce, N. R., Margolick, J. B., Kost, M., et al. (2024) · The Journal of Trauma: Injury, Infection, and Critical Care · doi:10.1097/ta.0000000000004365 · Cited by 4
Prevalencia del dolor en enfermos oncológicos. Dolor irruptivo
Castro, R. L. (2015) · Medicina Paliativa · doi:10.1016/s1134-248x(15)30002-1 · Cited by 4
Thermal sensitivity across ages and during chronic fentanyl administration in rats
Mitzelfelt, J. D., Carter, C. S., & Morgan, D. (2013) · Psychopharmacology · doi:10.1007/s00213-013-3208-4 · Cited by 4
Gasser, L., Lener, S., Hartmann, S., Löscher, W. N., Thomé, C., & Hofer, A. (2022) · Neurosurgical Review · doi:10.1007/s10143-022-01818-z · Cited by 4
[Commentary] CAN ONE BE AN EXPERT IN ADDICTION MEDICINE WITHOUT EXPERTISE IN PAIN MANAGEMENT?
SAMET, J. H., & WALLEY, A. Y. (2008) · Addiction · doi:10.1111/j.1360-0443.2008.02399.x · Cited by 4
Opiophobie: état des lieux auprès des soignants à Beira Interior au Portugal
Verloo, H., Kabengele, E. M., Ferreira, M. K. D. S., Rapin, C. H., & Chastonay, P. (2009) · Douleur et Analgésie · doi:10.1007/s11724-009-0134-7 · Cited by 4
Psychological interventions: a focus on cognitive‐behavioral therapy
Day, M. A., & Thorn, B. E. (2022) · Wiley eBooks · doi:10.1002/9781119701170.ch26 · Cited by 4
Lange, J., Gaddis, G., Varner, E., Schmidt, S., Cohen, R. E., & Schwarz, E. S. (2018) · Europe PMC (PubMed Central) · Cited by 3
Characteristics of ambulatory spine care visits in the United States, 2009–2016
Schneider, B. J., Haring, R. S., Song, A., Kim, P., Ayers, G. D., Kennedy, D. J. “. J. ”., & Jain, N. B. (2021) · Journal of Back and Musculoskeletal Rehabilitation · doi:10.3233/bmr-200145 · Cited by 3
Mimassi, N., Marchand, F., & Ganry, H. (2012) · Douleur et Analgésie · doi:10.1007/s11724-012-0289-5 · Cited by 3
Zaman, B., Hemati, K., Hasani, V. A., Daryaei, P., & Faezipour, H. (2009) · Cited by 2
Fischer, B., Burnett, C., & Rehm, J. T. (2014) · Drugs Education Prevention and Policy · doi:10.3109/09687637.2014.936827 · Cited by 2
Adámek, S., Matoušková, O., Polanecký, O., Světlík, S., Skořepa, J., & Snajdauf, M. (2013) · Prague Medical Report · doi:10.14712/23362936.2014.10 · Cited by 2
Bindicsova, I., Hides, L. M., Brain, K., Hodson, F. J., Jackson, P., Jensen, M. P., Ehde, D. M., & Day, M. A. (2025) · Journal of Pain · doi:10.1016/j.jpain.2025.105429 · Cited by 1
Best Practices Education, Part II: Evidence for and Against Opioid Therapy
McAnally, H. B. (2017) · Springer eBooks · doi:10.1007/978-3-319-47497-7_7 · Cited by 1
Understanding the Agent, Part II: Adverse Effects
McAnally, H. B. (2017) · Springer eBooks · doi:10.1007/978-3-319-47497-7_3 · Cited by 1
Treatment profiles and costs of patients with chronic pain in the population setting
Mainar, A. S. (2012) · ClinicoEconomics and Outcomes Research · doi:10.2147/ceor.s26116 · Cited by 1
Opioide bei muskuloskelettalen Schmerzen
Siegel, L., Pierer, M., Stein, C., & Baerwald, C. (2008) · Zeitschrift für Rheumatologie · doi:10.1007/s00393-008-0351-0 · Cited by 1
Endoscopic ultrasound: a powerful tool to modify treatment algorithms in opioid-induced achalasia
Lee, A. M., Holmgren, J., Broderick, R. C., Cheverie, J. N., Sandler, B. J., Jacobsen, G. R., Kwong, W., Kunkel, D. C., & Horgan, S. (2020) · Surgical Endoscopy · doi:10.1007/s00464-020-07882-0 · Cited by 1
Predicting Opioid Prescribing Behaviors: Influence of an Expert Opioid-Risk Evaluation
Vargovich, A. M. (2014) · The Research Repository @ WVU (West Virginia University) · doi:10.33915/etd.6866 · Cited by 1
Preparation of neoclerodane diterpenes as probes for the opioid receptor system
Lozama, A., Prisinzano, T. E., Wiemer, D. F., Doorn, J. A., Olivo, H. F., Salem, A. K., & Duffel, M. W. (2010) · doi:10.17077/etd.57godcye · Cited by 1
Reactive Oxygen Species Modulation of the Mu-Opioid Receptor
Langsdorf, E. F. (2011) · Seton Hall University eRepository (Seton Hall University)
Ashrafioun, L. (2014) · ScholarWorks@BGSU (Bowling Green State University)
Cannabinoids for Chronic Noncancer Pain Management: A Focused Literature Review
Dutton, M. A. (2012) · Research Exchange (Washington State University)
Elabd, S. (2010) · Topics in Pain Management · doi:10.1097/01.tpm.0000391336.52985.bc
Smjernice o uporabi opioida u liječenju kronične nekarcinomske boli
Jukić, M., Puljak, L., Katić, M., Kogler, V. M., Marković, B. B., Kvolik, S., & Fingler, M. (2014) · Medix : specijalizirani medicinski dvomjesečnik
Targeting opioid receptor signal transduction to produce sustained analgesia
Bull, F. A. (2015) · Discovery Research Portal (University of Dundee)
How Much Is Too Much? Are Opioids Always the Answer to Pain?
Rana, H. (2015) · Pain Physician · doi:10.36076/ppj.2015/18/e1119
Doyle, H. H. (2022) · Digital Archive @ GSU · doi:10.57709/10165308
Perrone, R. D., & Amro, O. W. (2018) · Springer eBooks · doi:10.1007/978-1-4939-7784-0_15
Opioide bei muskulo- skelettalen Schmerzen
Baerwald, C., Verlag, S. M., & Siegel, L. (2008)
Writers, A. M. (2013) · Drugs & Therapy Perspectives · doi:10.1007/s40267-013-0019-y
Defining Chronic Pain and its Territory
Day, M. A. (2017) · Wiley eBooks · doi:10.1002/9781119257875.ch1
Psychosocial Chronic Pain Management
Day, M. A. (2017) · Wiley eBooks · doi:10.1002/9781119257875.ch2
Berland, D., & Haider, N. (2012) · Perioperative Medicine · doi:10.1002/9781118375372.ch35
(2010) · Pain Physician · doi:10.36076/ppj/2010
Hresko, N. I., Бекесевич, А. М., Вільхова, І. В., Kyryk, K. A., & Hresko, I. V. (2022) · Science and Education a New Dimension · doi:10.31174/send-nt2022-268x34-04
Hresko, N. I., Kyryk, K. A., Бекесевич, А. М., Подолюк, М. В., & Tanchyn, I. A. (2024) · Bulletin of Problems Biology and Medicine · doi:10.29254/2523-4110-2024-2-173/addition-24-26
Day, M. A., Ciol, M. A., Ehde, D. M., Mendoza, M. E., Borckardt, J. J., Newman, A. K., Chan, J. F., Friedly, J. L., Reed, D. E., Drever, S. A., et al. (2025) · Pain Practice · doi:10.1111/papr.70107
Rojas, C. R. (2012) · LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas)
Day, M. A., Ciol, M. A., Mendoza, M. E., Borckardt, J., Ehde, D. M., Newman, A. K., Chan, J. F., Drever, S. A., Friedly, J. L., Burns, J. W., et al. (2024) · Figshare · doi:10.6084/m9.figshare.25596414
Brinkmöller, S., Poß-Doering, R., Straßner, C., & Laux, G. (2026) · Journal of Pain Research · doi:10.2147/jpr.s599161
Menéndez‐González, M. (2026) · Neuromethods · doi:10.1007/978-1-0716-5241-1_16
Metadata
- Authors
- Trescot, A. M.
- Affiliations
- University of Florida (US)
- Corresponding author
- Trescot, Andrea M.
- ORCID
- Trescot, Andrea M.
- Venue
- Pain Physician
- Published
- 2008-03-14
- Volume
- 2s;11
- Issue
- 3;2s
- Pages
- S181-S200
- ISSN
- 1533-3159 (ISSN-L)
- 2150-1149
- OpenAlex
- W2176833613
- Cited by
- 169
- References
- 110
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 4 · 2023: 2 · 2022: 10 · 2021: 5 · 2020: 2 · 2019: 5 · 2018: 13 · 2017: 7 · 2016: 9 · 2015: 11 · 2014: 12 · 2013: 14 · 2012: 18
- FWCI
- 17.47
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Pain Physician (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 › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Pain Management
- Keywords
- opioids, chronic non-cancer pain, long-term opioid therapy, morphine, transdermal fentanyl, oxycodone, hydrocodone, analgesia, functional improvement, opioid side effects, opioid use disorder, controlled substances
- MeSH terms
- Analgesics, Opioid, Drug Administration Schedule, Fentanyl, Humans, Methadone, Morphine, Oxycodone, Oxymorphone, Pain, Quality of Life, Time Factors, Tramadol
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review