Research shows there are some short-term benefits of opioid therapy in certain situations, but there are no studies showing the long-term effectiveness of opioids for chronic pain.
As a result, a paradigm shift is underway from opioids to nonopioid analgesics, according to James T. Jennings, M.D., medical director of adult primary care for Norton Medical Group and family medicine physician with Norton Community Medical Associates – Brownsboro.
Cochrane Reviews, looking at which medications produced a 50 percent decrease in acute pain after six months, found ibuprofen and acetaminophen were more effective than oxycodone. For example, 40% of those taking 200 milligrams of ibuprofen and 500 milligrams of acetaminophen experienced a 50 percent reduction in pain, compared with only 21 percent taking 15 milligrams of oxycodone.
A study of 240 patients published in the Journal of the American Medical Association in 2018 concluded opioids were no better than nonopioids in treating moderate to severe chronic back pain or osteoarthritis pain in the hip or knee. Adverse medication-related symptoms also were significantly more common in the opioid group over 12 months, according to the study.
Opioids are beneficial for acute trauma because they have a significant anxiolytic effect and reduce the incidence of posttraumatic stress disorder, according to Dr. Jennings. Even in acute use, however, opioids need to be prescribed for the shortest duration possible.
One study found that even extremely short-term use can impact how many patients are taking opioids one year later. Someone taking opioids for one day has a 6% chance of using opioids a year later. Eight days of opioid use raises the risk to 13.5%. Someone taking opioids for 31 days has a 29.9% chance they’ll be taking them a year later. Short-term use of opioids is defined as fewer than 90 days.
Patients have a higher risk of becoming addicted if:
- They have an anxiety or mood disorder
- They have a family history of substance abuse
- They are taking a higher dose or more frequent dose
Norton Medical Group has created detailed guidelines for physicians and advanced practice providers prescribing controlled substances for pain. Under the guidelines, “practitioners shall not prescribe a long-acting or controlled-release opioid (e.g., oxycodone, fentanyl patches or methadone) for acute pain that is not directly related to and close in time to a specific surgical procedure or major trauma.”
The guidelines also call for checking the patient’s history with pain medication during the past 12 months, educating the patient and prescribing no more than a seven-day supply of opioids for opioid-naïve patients.
Continuing education on opioid abuse
Continuing medical education (CME) credits are available through online learning at NortonHealthcare.com/CME. Click on “CME Activities” and then “Online Activities.” In the search field, type in “HB1” to see available learning opportunities about opioids or view here.
Physicians now can access convenient continuing medical education through the monthly “MedChat” podcast. “MedChat” fills a unique professional gap and is structured around a conversation addressing key issues for each topic. “MedChat” episodes last 30 minutes, so you can listen on your way to work, while walking the dog, eating your lunch or during another convenient time for you.
Subscribe to “MedChat” through your favorite podcast app or access the “MedChat” podcast here.