Major Review Finds Limited Short-Term Benefits From Opioids for Acute Pain
A new review led by researchers at the University of Sydney has found that opioid pain medicines often provide only modest, short-term relief for acute pain and, for several conditions, may offer no meaningful benefit compared with placebo.
Published in the journal Drugs, the study examined 59 systematic reviews covering more than 50 acute pain conditions in adults and children. The medicines assessed included codeine, morphine, oxycodone and tramadol. Researchers described the work as the most comprehensive assessment to date of opioid effectiveness and safety across acute pain conditions.
The review found that opioids may provide modest short-term relief in some cases, including abdominal pain, dental surgery, ear procedures, traumatic limb injuries, childbirth, caesarean delivery and bunion surgery. However, the drugs showed no clear advantage over placebo for other conditions, including some limb surgeries, kidney stone pain, pain after tonsil removal and pain in newborns using assisted breathing devices. Evidence was mixed for heart-related pain, pain after hysterectomy and topical opioid use for skin pain.
For acute musculoskeletal pain, a common reason for opioid prescribing, oral opioids were only slightly more effective than placebo during the first six to 48 hours of treatment. The researchers also found increased risks of side effects, including nausea and vomiting, in several settings such as musculoskeletal pain, traumatic limb injury and some post-surgical pain.
The authors noted broader safety concerns associated with opioid use, including tolerance, dependence, misuse, overdose, hospitalization and death. They also said side effects were often poorly reported in clinical trials, meaning risks may be undercounted.
The researchers concluded that the evidence does not support routine opioid use for acute pain. They advised that, when opioids are prescribed, patients should be informed of potential harms and doctors should use the lowest effective dose for the shortest appropriate time.