Opioids may provide only limited benefits for the management of chronic noncancer pain and may be associated with a greater risk for vomiting, according to a systematic review and meta-analysis published in JAMA.

In this review of 96 randomized clinical trials (n=26,169 participants; 61% women; median age, 58 years), 25 studies examined neuropathic pain, 32 trials focused on nociceptive pain, 33 studies were on individuals with central sensitization, and 6 studies had participants with mixed pain types. Each study was assessed for quality of evidence and examined primary outcomes (eg, pain intensity, physical functioning, and incidence of vomiting) as well as secondary outcomes (eg, sleep quality and social functioning).

In studies in which opioids were compared with placebo for the treatment of chronic noncancer pain (42 trials; n=16,617 patients; study duration, ≥3 months; high-quality evidence), opioid treatment vs placebo was associated with greater pain reduction (weighted mean difference,–0.69 cm on 10-cm visual analog scale; 95% CI, –0.82 to –0.56 cm), improved physical functioning (weighted mean difference on 100-point Short Form physical component score, 2.04 points), and greater sleep quality. Opioids were also associated with increased vomiting compared with placebo (5.9% vs 2.3%, respectively).

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Trials with low- to moderate-quality evidence indicated comparable improvements with opioids when these drugs were compared with nonsteroidal anti-inflammatory drugs (pain: weighted mean difference, –0.6 cm; 95% CI, -1.54 to 0.34 cm; physical functioning: weighted mean difference, –0.9 points; 95% CI, -2.69 to 0.89 points); with tricylic antidepressants (pain: weight mean difference, –0.13 cm; physical functioning: weighted mean difference, –5.31 points); and with anticonvulsant drugs (pain: weighted mean difference, –0.9 cm; physical functioning: weighted mean difference, 0.45 points).

Study limitations include of the lack of long-term assessment of the effect of opioid medications.

“Opioids may provide benefit for chronic noncancer pain, but the magnitude is likely to be small,” noted the review authors.


Busse JW, Wand Li, Kamaleldin M, et al. Opioids for chronic noncancer pain: a systematic review and meta-analysis. JAMA. 2018;320(23):2448-2460.

This article originally appeared on Clinical Pain Advisor