Opioid Analgesic Use For Pain Relief in Chronic Noncancer Pain

PainRelief.com Interview with:
Dr Stephanie Mathieson
NHMRC Health Professional Research Early Career Fellow
The University of Sydney
Faculty of Medicine and Health, Sydney School of Public Health
Institute for Musculoskeletal Health
Royal Prince Alfred Hospital Australia

PainRelief.com:  What is the background for this study?

Response: Chronic non-cancer pain, such as chronic non-specific low back pain has a substantial impact on society by costing billions of dollars each year in health care costs and lost productivity.

Current clinical practice guidelines for the management of chronic non-cancer pain, such as those from the Centers for Disease Control and Prevention, now recommend avoiding the initial use of opioid analgesics, as the risk of harms, such as overdose and death.

We wanted to establish the extent to which opioid analgesics are used by people with chronic noncancer pain. This is important, as many studies report how many opioids are prescribed, but this may not represent the actual use of opioid analgesics.

PainRelief.com: What are the main findings?

Response: Our review found 60 eligible studies reporting data on opioid use in people with chronic non-cancer pain from 1990 to 2017. Opioid use was reported by 26.8% (95% confidence interval [CI], 23.1% to 30.8%; moderate-quality evidence) of the 3,961,739 participants with chronic non-cancer pain. Opioid use was greater in people with chronic low back pain (29.8% (95% CI, 20.5–41.2; n = 8 studies; moderate quality evidence).

In those with chronic non-cancer pain, the use of weak opioids (17.3%; 95% CI 11.9% to 24.4%; moderate-quality evidence) was more common than the use of strong opioids (9.8%; 95% CI, 6.8% to 14.0%; low-quality evidence).

Meta-regression identified that opioid use was lower in Europe than North America, and opioid use was not associated with the type of chronic pain diagnosis nor had changed over time

PainRelief.com: What should readers take away from your report?

Response: Between 1990 and 2017, one-quarter of people with chronic non-cancer pain and nearly one-third of people with chronic low back pain reported taking opioids, and this proportion did not change over time

PainRelief.com: Is there anything else you would like to add?

Response: Our other research has identified that opioid analgesics prescribed to patients with chronic non-cancer pain has increased over time (doi 10.1111/joim.13026). Therefore, not all patients with chronic non-cancer pain take opioid analgesic medicines they are prescribed. Future research may explore the reasons behind these differences.


Graeme Wertheimer, MD, Stephanie Mathieson, PhD, Christopher G Maher, DMedSc, Chung-Wei Christine Lin, PhD, Andrew J McLachlan, PhD, Rachelle Buchbinder, PhD, Sallie-Anne Pearson, PhD, Martin Underwood, MD, The Prevalence of Opioid Analgesic Use in People with Chronic Noncancer Pain: Systematic Review and Meta-Analysis of Observational Studies, Pain Medicine, , pnaa322, https://doi.org/10.1093/pm/pnaa322

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