The CDC recommends non-opioid alternatives for chronic pain, but some alternatives are more effective than others and some can be harmful. In this slideshow, we review the evidence.
The Centers for Disease Control and Prevention recommends that physicians prescribe non-opioid alternatives for chronic pain, but some alternatives are more effective than others and some can be harmful. In this slideshow, we review the effectiveness and harms of nonpharmacologic and nonopioid pharmacologic treatments as described by the CDC in its 2016 opioid prescribing guidelines.See related coverage from Rheumatology Network:Best Practices in Prescribing Opioids for Chronic PainPrescribing opioids for chronic pain may be associated with some short-term efficacy, but there may be other alternatives physicians should consider.A Review of Central Pain in Rheumatic DiseasesDMARDs and surgery are unlikely to be effective as sole therapies when central pain vs. peripheral pain is suspected in lupus, RA and osteoarthritis.
Chaparro LE, Furlan AD, Deshpande A, Mailis-Gagnon A, Atlas S, Turk DC. Opioids compared with placebo or other treatments forchronic low back pain: an update of the Cochrane Review. Spine (Phila Pa 1976). 2014;39(7):556-563.
Fransen M, McConnell S, Harmer AR, Van der Esch M, SimicM, Bennell KL. Exercise for osteoarthritis of the knee. Cochrane Database SystRev. 2015;1:CD004376.
Fransen M, McConnell S, Hernandez-Molina G, Reichenbach S. Exercise for osteoarthritis of the hip. Cochrane Database Syst Rev. 2014;4:CD007912.
HäuserW, Urrútia G, Tort S, Uçeyler N,Walitt B. Serotonin and noradrenaline reuptake inhibitors (SNRIs) for fibromyalgia syndrome. CochraneDatabase Syst Rev. 2013;1:CD010292.
Hayden JA, van TulderMW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database SystRev. 2005;(3):CD000335.
Lee C, Crawford C, Swann S; Active Self-Care Therapies for Pain (PACT)Working Group. Multimodal, integrative therapies for theself-management of chronic pain symptoms. Pain Med. 2014;15(suppl 1):S76-S85.
Lunn MP, Hughes RA, Wiffen PJ. Duloxetine for treating painful neuropathy, chronic pain or fibromyalgia. Cochrane Database Syst Rev. 2014;1:CD007115.
Moore RA, Straube S, Wiffen PJ, Derry S, McQuay HJ. Pregabalin for acute and chronic pain in adults. Cochrane Database Syst Rev. 2009;8(3): CD007076.
Moore RA, Wiffen PJ, Derry S, Toelle T, Rice AS. Gabapentin for chronic neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev. 2014;4:CD007938.
Roelofs PD, Deyo RA, Koes BW, Scholten RJ, van TulderMW. Nonsteroidal anti-inflammatory drugs for low back pain: an updated Cochrane review. Spine (Phila Pa 1976). 2008;33(16):1766-1774.
Saarto T, Wiffen PJ. Antidepressants for neuropathic pain: a Cochrane review. J NeurolNeurosurg Psychiatry. 2010;81(12):1372-1373.
Salerno SM, Browning R, Jackson JL. The effect of antidepressant treatment on chronic back pain: ameta-analysis. Arch Intern Med. 2002;162(1):19-24.
Staiger TO, Gaster B, Sullivan MD, Deyo RA. Systematic review of antidepressants in the treatment of chronic low back pain. Spine (Phila Pa 1976). 2003;28(22):2540-2545.
Welsch P, Sommer C, Schiltenwolf M, Häuser W. Opioids in chronic noncancer pain: are opioids superior to nonopioid analgesics? a systematic review and meta-analysis of efficacy, tolerability and safety in randomized head-to-head comparisons of opioids versus nonopioid analgesics of at least fourweek’s duration [in German]. Schmerz.2015;29(1):85-95.
Wiffen PJ, Derry S, Moore RA, Kalso EA. Carbamazepine for chronic neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev. 2014;4:CD005451.
