For most chronic pain, opioids can be a bad choice

Patients taking opioid painkillers for chronic pain not from cancer - conditions such as headaches, fibromyalgia, and low-back pain - are more likely to risk overdose, addiction, and a range of debilitating side effects than they are to improve their ability to function, a leading physicians group said.

The long-term use of opioids may not, in the end, be beneficial even in patients with more severe pain conditions, including sickle-cell disease, destructive rheumatoid arthritis, and severe neuropathic pain, the American Academy of Neurologists said in a new position statement.

But even for patients who do seem to benefit from opioid narcotics, the neurology group warned, physicians who prescribe these drugs should be diligent in tracking patients' dosage increases, screening for a history of depression or substance abuse, looking for signs of misuse, and insisting as a condition of continued use that opioids are improving patients' functioning.

The neurology academy is hardly the first doctors' group to sound the alarm on these drugs and call for more restraint in prescribing them.

But it seems to be the first to lay out a comprehensive set of research-based guidelines that outline which patients are most and least likely to benefit from continued use of opioids, and what practices physicians should follow in prescribing them for pain.

The statement would govern the prescribing of morphine, codeine, oxycodone, methadone, fentanyl, hydrocodone, and combinations of those drugs with acetaminophen.

- L.A. Times