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 Strong Painkillers Only Moderately Effective Against Chronic Pain 
by Healthy News - 4/11/2008
Caution urged in use of opioids to treat long-term pain; safety issues unresolved  

(Washington, D.C.) – The strongest painkilling drugs – called opioids – should not be first-line treatments against chronic pain, and are only moderately effective when they are prescribed, according to the latest report from Consumer Reports Best Buy Drugs™, a public education project of Consumers Union.           

Doctors and patients should instead first try less risky and less expensive pain relievers, such as acetaminophen (the ingredient in Tylenol), non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin IB and generics), and naproxen (Aleve and generics), or non-opioid prescription pain medicines.     

Evidence indicates that these common painkillers used by millions of people at low doses everyday to treat mild aches and pains are often just as effective as opioids –  and less risky – against chronic pain when used at somewhat higher doses, the report concludes.   

Chronic pain has many causes, including injuries that fail to heal properly, nerve damage from diseases, and aging joints.  And sometimes it arises for no apparent physical reason.   It’s also defined as any pain that lasts longer than three to six months.   

The report – written for consumers and available free at – analyzes and compares 12 opioid medicines.   It’s the 20th report in a series that helps consumers talk with their doctors about their medicines and find drugs that give them the best value for their health care dollar.  Previous reports tackle drugs to treat high cholesterol, high blood pressure, depression, asthma, allergies, Alzheimer’s disease, insomnia, menopause, and migraine headaches.   

Opioids have long been controversial because they can be addictive and are prone to abuse and misuse as recreational drugs.  When used by people not in pain, the drugs cause sedation, a sense of calm, and elation.  Opioids like OxyContin, Vicodin, Demerol, Darvon, and Percocet have become household names primarily because of their link to abuse and misuse.   
At the same time, the opioids have sometimes been under-prescribed to treat people who genuinely need them because doctors fear misuse, the risk of addiction and other problems. 

“This is a one of the most challenging group of medicines to use wisely – for doctors and patients,” says Orly Avitzur, M.D. M.B.A, a neurologist and Medical Adviser to Consumers Union and Consumer Reports. “What this new report shows is that while the opioids have a role to play in treating some people with chronic pain, they should be used with extra caution and certainly should not be the first drug tried.”  

One reason for that, according to the report, is mounting evidence that links the long-term use of opioids to adverse effects.  These include a decrease in sex hormones leading to both a loss of interest in sex and impaired sexual function; a decline in immune function; and an increase the body’s sensitivity to pain.  These problems don’t appear to be permanent and will go away when use of the opioid is stopped.  

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Provided by Healthy News on 4/11/2008
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