Authors also report an increase in vomiting with opioids (5.9% vs 2.3%), and that comparisons of opioids with nonopioid alternatives suggested that the benefit for pain and functioning may be similar, although the evidence was from studies of only low to moderate quality.
A related commentary discusses this research. The outcomes reported in this study are likely to represent the best-case scenario because 72% of the included studies excluded patients with current or prior substance use disorder and 47%of the studies excluded patients who had a diagnosed mental illness or who were taking a psychotropic medication. However, this often is not the case in the clinical setting. The management of chronic noncancer pain deserves increased attention. Effective, appropriate treatment can make a difference in the lives of individuals with chronic pain. Opioid therapy can be safe and effective in carefully selected patients when proper ongoing monitoring is integrated into patient care. However, it is time for physicians to redouble efforts to improve the process of care when prescribing opioids. Diligent opioid prescribing to carefully selected patients will lower the risk of harm to patients, their families, and the community.