Opioids for relief of chronic pain? Try less risky treatments first

Consumer Reports News: April 10, 2008 04:35 PM

Chronic pain is one of medicine's conundrums. It has a myriad of causes, including injuries that fail to heal properly, nerve damage, and aging joints. And sometimes it seems to arise for no apparent reason. It's notoriously tough to treat.

As a result, people with chronic pain face a host of frustrations and often try many treatments and painkillers before finding relief. A new report from the Consumer Reports Best Buy Drugs project offers fresh guidance on using the strongest of these painkillers—called the opioids—to treat chronic pain.

This 20th Best Buy Drug report compares 12 opioids. We've chosen four generics as Best Buys for people who have chronic pain and whose doctors have concluded that an opioid is necessary. Based on their relative low cost, the evidence for effectiveness, safety, side effects, and dosing convenience and flexibility, the Best Buys are:

  • Codeine plus acetaminophen
  • Morphine extended release
  • Oxycodone extended release
  • Oxycodone with acetaminophen

These four medicines have a long track record and provide good value. They range widely in monthly cost, depending on dosing regimen. But most low-dose regimens will run you less than $150 a month or so.

There's no reason to take the brand-name versions of these drugs—Tylenol #3 or #4, MS Contin, OxyContin, or Percocet—or any opioid for that matter.

Evidence links the long-term use of opioids to some unpleasant side effects, such as loss of interest in sex and impaired sexual function; a decline in immune function; and an increase in the body's sensitivity to pain.  Also, the opioids carry the risk of being addictive and are prone to abuse and misuse. In people who genuinely need them to control moderate to severe pain, addiction is rare, however.

Our report finds that many consumers believe their chronic pain warrants the strongest of pain relievers. But the evidence actually shows that everyday pain relievers, when used in moderate to high doses, can be just as effective as the opioids against many forms of chronic pain—like back pain, osteoarthritis, and recurring muscle pain. And they are a lot safer.

If you suffer from chronic pain we also advise you to talk with your doctor about non-drug measures. Several, including cognitive behavioral therapy, exercise, spinal manipulation, and physical rehab programs, have been shown to ease pain and/or improve quality of life.

The bottom line: don't use opioids until you have tried other, less risky, pain relievers first, and failed to get adequate relief. Those include acetaminophen (Panadol, Tylenol, and generic), non-steroidal anti-inflammatory drugs (the so-called NSAIDs), such as ibuprofen (Advil, Motrin, and generic) and naproxen (Aleve, Naprosyn, and generic), or other non-opioid prescription painkillers.

To find out more about the uses and side effects of the drugs in this class, read our FREE Consumer Reports Best Buy Drugs report.

—Steve Findlay, managing editor, Consumer Reports Best Buy Drugs

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