Opioid drugs work very well to alleviate severe short-term pain due to, say, surgery or a broken bone. They can also help with pain associated with terminal or very serious illnesses, such as cancer. But for longer-term pain from, for example, arthritis, lower-back pain, or nerve pain, research suggests that other medications and even nondrug treatments often provide relief with less risk.
Still, an estimated 90 percent of people with chronic pain are prescribed opioids. Unfortunately, most probably don’t find much relief. For example, in a 2010 study of more than 1,000 people suffering chronic pain, mostly commonly leg and back pain, most of those taking opioids reported that they still suffered moderate-to-severe pain that interfered with their everyday activities.
Truth is, there’s limited evidence that opioids help or are safe when used long term. Most of the research involves lower-risk patients who used the drugs for just a few weeks. Very few studies have compared opioids to safer options for relieving pain, such as OTC drugs or even nondrug measures.
“What concerns me is that there is no clear evidence that people who take opioids over the long term can do more or get around more easily,” said Gary Franklin, M.D., research professor of environmental and occupational health sciences at University of Washington in Seattle. “But we do know that the higher the dose of the drug and the longer you take it, the greater your risk.”
Some people do find that high doses take the edge off their pain, but the nausea, constipation, and “fuzzy-headedness” that commonly result from taking strong doses of an opioid make it not worth the benefit. On the other hand, people who start on lower doses often develop a “tolerance” to the drug, so it takes progressively larger doses to get the same relief. In an unfair twist, occasionally, the drugs can actually make people more sensitive to pain.
As if that’s not enough, long-term use of opioids can weaken your immune system and affect sex hormones—disrupting women’s menstrual cycles, causing men to have difficulty achieving an erection, and reducing sexual desire in both sexes.
“The old perception about opioids is that they are reasonably effective and safe for chronic pain,” Roger Chou, M.D., associate professor of medicine at Oregon Health and Science University in Portland, said. "But what we’ve come to realize is for many types of pain they don’t work all that well and are actually associated with significant harm.”
What to do: For some types of pain—in particular, nerve pain, migraines, and fibromyalgia—other prescription medications often work better than opioids. For other types of chronic pain, talk to your doctor about trying garden-variety pain relievers such as acetaminophen (Tylenol and generic), ibuprofen (Advil, Motrin IB, and generic), or naproxen (Aleve and generic) before resorting to the stronger stuff. Research suggests that people with mild-to-moderate chronic pain can also find significant relief through nondrug measures.
If you have severe, debilitating pain that hasn’t responded to other treatment, then opioids may be option. But your doctor should prescribe the lowest possible dose for the shortest possible time and monitor you regularly for side effects.
For more details on using opioids to treat chronic pain, see our Best Buy Drugs report.