Insufficient Evidence: How Opioid Deniers Spin Studies — Pain News Network – By Roger Chriss – April 2017
Researchers cannot and do not investigate if “opioids” work for “chronic pain.”
Good research is more narrowly focused, such as these clinical studies:
- “Tapentadol extended release for the management of chronic neck pain”
- “Effectiveness and Safety of Once-Daily Extended-Release Hydrocodone in Individuals Previously Receiving Immediate-Release Oxycodone for Chronic Pain”
- “Oxycodone for neuropathic pain in adults”
The results are equally specific.
In the first example above, the authors conclude that
“our results suggest that tapentadol ER, started at 100 mg/day, is effective and well tolerated in patients with moderate-to-severe chronic neck pain, including opioid-naïve subjects.”
Similarly precise statements are found in any such article.
Sometimes researchers will perform a meta-analysis or review in which they assemble a collection of existing research articles and, after a statistical analysis, attempt to draw broader conclusions. Examples include:
Opioid medications are coming under fire again as being ineffective for chronic pain management.
Charles Pattavina, MD, president of the Maine Medical Association, told the Portland Press Herald that “there is no clinical indication for opioid medication for the treatment of chronic pain.”
The last article above is often cited by opioid deniers, even though it concludes that “evidence is insufficient to determine the effectiveness of long-term opioid therapy for improving chronic pain and function.”
And Stanford psychiatrist Anna Lembke, MD, said in Vox that “if opioids worked long-term, I would have no problem with patients taking them.”
But sweeping generalizations like these oversimplify a complex situation.
Chronic pain is a highly heterogeneous feature of a wide variety of diseases and disorders.
And opioids are a broad class of pain medications that come in different doses and are administered by different routes.
Thus, a claim that opioids do not work for chronic pain is too simplistic.
“Evidence is insufficient” means that no determination can be made one way or the other about opioid medications. It does not prove that opioids are ineffective for chronic pain
This leads to the final defense of opioid deniers: Demand an impossibly high standard of evidence.
Specifically, they want the “gold standard” of clinical research: a double-blind, placebo-controlled, randomized trial of a specific drug for a particular condition.
To satisfy this standard, we would have to test every opioid medication against every medical condition causing chronic pain in a variety of different groups of people.
This would mean thousands of trials, each performed multiple times, before any meaningful conclusions could be drawn about opioid medications in general. The time and costs involved would be prohibitive in the extreme.
To be clear, opioid therapy can help manage a variety of forms of chronic pain. Not all pain, and not for all patients. And always under the care and guidance of medical professionals.
The goal of opioid therapy is to improve quality of life, and available evidence strongly supports that it does so.