Thanks again for this, very interesting. I’ve tried looking at some Cochrane Collaboration reviews of this, and I’m getting the impression that
(a) opioids do not always achieve “night-and-day” dramatic improvement in welfare
(b) while addiction is rare, various other negative side-effects are common
This review on long term treatment of non-cancer pain agreed that addiction was rare, but found that “Many participants discontinued due to adverse effects (oral: 22.9%; transdermal: 12.1%; intrathecal: 8.9%, etc ”
It also said that “Findings regarding quality of life and functional status were inconclusive”. While the reason given for this is lack of evidence, it seems that if material numbers of participants are discontinuing, it can’t be the case that almost all of them are having life-changing improvements in quality of life.
There are clearly differences in how people respond to opioids, both in terms of efficacy of pain relief and severity of side effects, and for some chronic pain patients there are other treatments that may be preferable. But for a substantial fraction of chronic pain patients, opioids appear to be the only medication that is sufficiently effective, justifying any side effects. Note also that these Cochrane studies refer only to non-cancer pain, whereas for terminal cancer patients—one of the main categories of pain patients addressed by the Lancet study—side effects that affect daily functioning may be even less important than pain relief.
Thanks again for this, very interesting. I’ve tried looking at some Cochrane Collaboration reviews of this, and I’m getting the impression that (a) opioids do not always achieve “night-and-day” dramatic improvement in welfare (b) while addiction is rare, various other negative side-effects are common
This review on long term treatment of non-cancer pain agreed that addiction was rare, but found that “Many participants discontinued due to adverse effects (oral: 22.9%; transdermal: 12.1%; intrathecal: 8.9%, etc ”
It also said that “Findings regarding quality of life and functional status were inconclusive”. While the reason given for this is lack of evidence, it seems that if material numbers of participants are discontinuing, it can’t be the case that almost all of them are having life-changing improvements in quality of life.
Another Cochrane Collaboration review found a 78% chance of (some) adverse side-effects, and a 7.5% chance of a serious adverse side-effect.
Just wanted to check whether I’ve understood this correctly?
There are clearly differences in how people respond to opioids, both in terms of efficacy of pain relief and severity of side effects, and for some chronic pain patients there are other treatments that may be preferable. But for a substantial fraction of chronic pain patients, opioids appear to be the only medication that is sufficiently effective, justifying any side effects. Note also that these Cochrane studies refer only to non-cancer pain, whereas for terminal cancer patients—one of the main categories of pain patients addressed by the Lancet study—side effects that affect daily functioning may be even less important than pain relief.