What is the evidence that opioids are effective in the treatment of CNCP

There have been a number of systematic reviews and meta-analyses of randomized controlled trials (RCTs).14 [I], 15[I], 16[I] These reviews have included many of the same studies and identified similar problems with the current literature on opioids for CNCP. They do, however, attempt to answer some of the questions we have posed. A summary of the data from these meta-analyses and systematic reviews is listed below (note: approximate values are listed).

• No RCTs have tested opioids for the treatment of CNCP in doses greater than 300 mg morphine (equivalent) per day (or methadone 80 mg per day), for more than 16 weeks.

• It was difficult to determine the effects of opioids on functional or quality of life outcomes.

• There was a significant placebo effect.

• The mean decrease in pain intensity was 30 percent (15-30 percent for placebo).

• The mean decrease in visual analog scale (VAS) pain score was 15/100.

• Between 5 and 10 percent of patients withdrew due to lack of opioid efficacy (20 percent for placebo).

• Between 50 and 80 percent of patients developed at least one opioid-adverse effect (30-60 percent for placebo).

• Between 20 and 30 percent of patients withdrew due to opioid-adverse effects (5-15 percent for placebo).

• Only 30 percent of RCT patients remained on long-term opioid therapy for the management of chronic pain.

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