Use of opioids for pain questioned at meeting

Shifts may be coming in parts of the medical community where heavy prescribing of opioid medicines has been commonplace. An FDA meeting this week took a look at the use of these high-powered medications for chronic pain. While the questions of appropriateness for purpose are just starting to get traction, a couple of early reports are revealing:

• among back pain patients, those who used opioids for more than a week were twice as likely not to be back to work in a year than those who used the meds for less than a week
• on the long term, opioids are not well tolerated
• no one seems to have a good estimate of how many patients respond well to long-term use

There is no dispute raised to the contention that opioids are essentially 'miracle drugs' in treating cancer pain, there is increasing concern about using them for other types of chronic (or even acute) pain. However, increasing attention is being drawn as a reaction to overdoses and spreading addiction problems.

Originally aimed at cancer pain and short-term relief after injury or surgery; in the mid-1990's, these narcotic-based medicines began to be touted as a good choice for chronic pain relief with a low risk of addiction. Much support for the expanded use and claims of safety were expressed by organizations which turned out to be heavily supported by the manufacturers of the drugs. In the decade between 1997 and 2007, prescriptions for opioids increased 400%. 

The two-day meeting was organized by the FDA and conducted in Bethesda, Maryland. It remains to be seen what will result from the effort.