Opioids for Chronic Pain

Background

Opioids are very strong prescription pain medicines. They are stronger than aspirin, Tylenol, Advil, and other pain medicines. They block pain signals in the body, and can act as sedatives, making you drowsy. Opioids are used to treat short-term acute pain, such as pain after surgery or pain caused by a wound, burn, bad sprain, or other injury. Opioids are also used to treat some kinds of long-term, chronic pain. This includes back pain, nerve pain, and pain caused by other long-term illnesses or conditions.

To help you and your doctor evaluate whether you need an opioid, and if so, which one may be best, Consumer Reports has evaluated the drugs in this category based on their effectiveness, safety, and cost.

This information is produced by Consumer Reports and Consumer Reports Best Buy Drugs, a public information project supported by grants from the States Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin.

Do You Need an Opioid?

Some kinds of chronic or periodic pain in particular—such as nerve pain, migraines, or fibromyalgia—are best treated with other types of drugs, not opioids. Talk with your doctor about nondrug measures, too. Studies show they can ease chronic pain, either alone or in combination with drugs. These include cognitive behavioral therapy, exercise, spinal manipulation, and physical rehab programs.

If you have chronic pain, we recommend:

  • Start with nondrug treatments, such as exercise, physical therapy, massage, and acupuncture.
  • If those don’t help, try acetaminophen (Tylenol).
  • If you still have pain or you also have inflammation, try ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn).
  • If these do not help, ask your doctor about opioids or other drugs.

Drugs for Types of Chronic Pain

Condition*

First Try

If That Doesn’t Work + Comments

Headaches

Acetaminophen, or a Nonsteroidal Anti-Inflammatory Drug (NSAID)1 if that does not work

See a doctor if headaches are severe, persistent, or accompanied by fever or vomiting, or if you have difficulty with speech or balance. Don’t self-medicate for more than two weeks.

Migraines

Acetaminophen, NSAIDs, Excedrin, Triptans

A triptan is needed if the others don’t work, especially if migraines are frequent and/or severe.

Menstrual cramps

NSAIDs

Several are marketed for cramps but any NSAID will probably work.

Pain due to minor trauma (bruises, scrapes, minor sprains)

Acetaminophen, NSAIDs

Opioids are not recommended.

Pain due to moderate or severe trauma (wounds, burns, fractures, etc.)

Opioids

Typically short-term, up to two weeks.

Post-surgical pain—minor

Acetaminophen, NSAIDs

Opioids rarely needed.

Post-surgical pain—moderate to severe

Opioids

Combinations of opioids may be prescribed if pain is severe.

Muscle aches

Acetaminophen, NSAIDs

If inflammation involved, NSAIDs may work better.

Muscle pulls

NSAIDs, Muscle Relaxants

If inflammation involved, NSAIDs may work better. Short-term use only.

Pain due to osteoarthritis

Acetaminophen, NSAIDs

See a doctor if pain persists.

Sprains

NSAIDs

Opioids may be needed for severe sprains.

Toothaches and pain following dental procedures

Acetaminophen, NSAIDs

Opioids may be needed if pain is severe; short-term use.

Pain due to heartburn or GERD2

Antacids, H2 Blockers (e.g. Tagamet, Zantac), Proton Pump Inhibitors (e.g. Prilosec OTC)

Heartburn that lasts more than a week needs medical attention. Aspirin and NSAIDs should be avoided.

Chronic back pain

Acetaminophen, NSAIDs

Opioids may be necessary if other drugs do not control pain and pain is persistent.

Pain from a kidney stone

Acetaminophen, NSAIDs, Opioids

Opioids usually needed if pain is severe.

Nerve pain3

Acetaminophen, NSAIDs, Anticonvulsants

Opioids are sometimes used, but only if anticonvulsants have been tried and don’t work. Antidepressants are another option.

Pain due to fibromyalgia4

Antidepressants, Anticonvulsants

Opioids have not proved effective in treating fibromyalgia.

*Important Note: The information in this table is not comprehensive. It is meant as general guidance and reflects typical medical practice. It should not substitute for a doctor’s advice. If you have pain that lasts for more than 10 days, see a doctor. The table is based on numerous sources and does not reflect analysis or input from the Drug Effectiveness Review Project (DERP). DERP is a first-of-its-kind, multistate initiative to evaluate the comparative effectiveness and safety of hundreds of prescription drugs. Always follow the labelling or package insert information on nonprescription and prescription drugs you use to treat pain.

1. Includes aspirin and aspirin-like drugs such as ibuprofen (Advil, Motrin, and generic) and naproxen (Aleve and generic).

2. GERD = Gastroesophageal Reflux Disease, also referred to as stomach acid reflux.

3. Associated with diabetic neuropathy, shingles, injury-related nerve damage, compression of nerves in the spine, and nerve damage associated with cancer or HIV infection.

4. Fibromyalgia is a condition marked by muscle and joint tenderness and pain. Fatigue can also be present. The cause is unknown. The symptoms it produces and their severity vary widely from person to person.

Our Recommendations

Taking effectiveness, safety and side effects, dosing flexibility and convenience, and cost into account, we have chosen the following opioid as a Consumer Reports Best Buy Drug for people with moderate to severe chronic pain when other pain relievers fail to bring adequate relief:

  • Generic morphine extended-release

This medicine has a long track record and provides good value. It ranges widely in monthly cost, depending on dosing regimen. But most low-dose regimens will cost less than $101 a month.

High doses of this medicine can be quite expensive. If you need to take a high dose, we advise speaking with your doctor or pharmacist about which opioid has the lowest cost under your insurance plan. If you have to pay out-of-pocket, take care to avoid the high-cost version of our Best Buy medicine, if possible.

Cost Comparison

Generic Name and Strength*

Brand Name(s)1

Frequency of Use per Day2

Total Daily Dose3

Average Monthly Cost4

Hydromorphone—pills

Hydromorphone 8 mg sustained-release

Exalgo

1

8 mg

$349

Hydromorphone 12 mg sustained-release

Exalgo

1

12 mg

$520

Morphine—pills

Morphine extended-release 15 mg

Generic

2

30 mg

$48

Morphine extended-release 30 mg

Avinza

1

30 mg

$177

Morphine extended-release 30 mg

MS-Contin

2

60 mg

$270

Morphine extended-release 30 mg

Kadian

1

30 mg

$247

Morphine extended-release 30 mg

Generic

2

60 mg

$72

Morphine extended-release 60 mg

Avinza

1

60 mg

$313

Morphine extended-release 60 mg

Kadian

1

60 mg

$433

Morphine extended-release 60 mg

Generic

2

120 mg

$101

Morphine extended-release 90 mg

Avinza

1

90 mg

$456

Morphine extended-release 100 mg

Kadian

1

100 mg

$692

Oxycodone—pills

Oxycodone extended-release 10 mg

OxyContin

2

20 mg

$164

Oxycodone extended-release 20 mg

OxyContin

2

40 mg

$306

Oxycodone extended-release 40 mg

OxyContin

2

80 mg

$529

Oxycodone extended-release 80 mg

OxyContin

2

160 mg

$1,031

Oxymorphone—pills

Oxymorphone extended-release 10 mg

Opana ER

2

20 mg

$290

Oxymorphone extended-release 15 mg

Generic

2

30 mg

$319

Oxymorphone extended-release 15 mg

Opana ER

2

30 mg

$343

Oxymorphone extended-release 20 mg

Opana ER

2

40 mg

$509

Oxymorphone extended-release 40 mg

Opana ER

2

80 mg

$955

*Selected opioids and doses. For a more complete listing, see our full report at CRBestBuyDrugs.org.

1. “Generic” indicates it’s the generic version of this drug.

2. As typically and generally prescribed. Means number of pills unless otherwise noted.

3. Total daily dose of opioid only.

4. Prices are based on nationwide retail average prices for July 2012. Consumer Reports Best Buy Drugs obtained prices from data provided by Symphony Health Solutions, which is not involved in our analysis or recommendations.

NOTE: The information contained in the Consumer Reports Best Buy Drugs™ reports is for general informational purposes and is not intended to replace consultation with a physician or other health care professional. Consumer Reports is not liable for any loss or injury related to your use of the reports. The reports are intended solely for individual, non-commercial use and may not be used in advertising, promotion, or for any other commercial purpose.


Copyright 2010, Consumers Union of United States, Inc

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