Opioids don’t work for most people with chronic pain. A pain expert explains why doctors should consider other options for their patients.
Despite a lack of evidence to support the use of opioids for chronic pain, they're still widely prescribed.
In fact, people in the U.S., less than 5 percent of the population on Earth, consume 80 percent of the world's opioids.
The director of Michigan Medicine's Chronic Pain and Fatigue Research Center, Daniel Clauw, M.D., says routine clinical practice underuses safer and potentially effective options for chronic pain conditions such as fibromyalgia, interstitial cystitis and irritable bowel syndrome.
"I haven't prescribed an opioid for chronic pain in at least a decade," Clauw says. "Narcotics don't work for most types of chronic pain, and overprescribing of narcotics in the United States has led to a serious public health problem with many deaths and overdoses. We need to modify how we approach individuals with chronic pain."
Other drug and nondrug treatments
Clauw urges providers to exhaust all other options before prescribing an opioid.
He says classes of drugs like tricyclic drugs, gabapentinoids and serotonin-norepinephrine reuptake inhibitors can be effective in treating chronic pain and are not always considered or used in individuals with chronic pain.
Exercise, cognitive behavioral therapy and a number of complementary and alternative therapies can also be quite effective for individuals with chronic pain, Clauw adds.
If someone is already using an opioid, he says gradually tapering the opioid doesn't usually make the pain worse. Some chronic pain patients actually feel better after they stop the opioids because opioids do come with side effects, he adds.
But Clauw acknowledges opioids may be reasonable and helpful for malignant pain and some cases of osteoarthritis and chronic low back pain, if other pharmacologic and nonpharmacologic therapies are not working.
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