Nonopioid Medications for Chronic Pain: An AHRQ Update
The AHRQ evaluates nonopioid medications including NSAIDs, gabapentinoids, antidepressants, and cannabinoids for efficacy in treatment of chronic noncancer pain.
Recently the federal government’s Agency for Healthcare Research and Quality (AHRQ) issued a report on the use of nonopioid medications for the management of chronic pain.1 The report was based on extensive literature reviews and sought to address 2 major questions regarding the use of nonopioids including:
1. Their effectiveness across a wide range of chronic pain conditions
2. Harms and adverse events associated with their use
The report offers several key findings with regard to the potential benefits of nonopioids for pain conditions for which the authors identifed sufficient literature to make recommendations on their use.
Those key findings are higlighted in the slide show below.
NEUROPATHIC PAIN. Use of anticonvulsant and SNRI antidepressant medication resulted in small improvements in pain.
NEUROPATHIC PAIN, cont. Capsacian patch may have a small effect on pain realted to PHN and HIV-related neuropathy but it can't be recommended. THC, CBD oral spray had inconsistent results on pain in MS or on allodynia.
FIBROMYALGIA. Agents evaulated: Duloxetine, SNRI milnacipran pregabalin, gabapentin, memantine (NMDA receptor antagonist).
OSTEOARTHRITIS. Agents evaluated: Nonsteroidal anti-inflammatory drugs (NSAIDs), topical diclofenac, acetaminophen, duloxetine.
OTHER PAIN CONDITIONS. NSAIDs were evaluated for inflammatory arthritis and duloxetine for low backpain.
HARMS, ADVERSE EVENTS ASSOCIATED WITH USE OF ANTIDEPRESSANTS FOR CHRONIC PAIN. Incidence of serious AEs was overall low; duloxetine associated with signficant, dose-dependent sedation.
HARMS, ADVERSE EVENTS ASSOCIATED WITH USE OF ANTICONVULSANTS FOR CHRONIC PAIN. Oxcarbazapine associated with large risk of withdrawal due to adverse events; pregabalin and gabapentin associated with large increases in CNS symptoms and weight gain.
HARMS, ADVERSE EVENTS ASSOCIATED WITH USE OF NSAIDS FOR CHRONIC PAIN. Small-to-moderate increases in risk for CV events with some NSAIDs; large increase in risk of coronary events with ibuprofen.
HARMS, ADVERSE EVENTS ASSOCIATED WITH USE OF NSAIDS FOR CHRONIC PAIN. Serious upper GI events seen with ibuprofen and naproxen; hepatic issues seen with diclofenac, naproxen.
HARMS, ADVERSE EVENTS ASSOCIATED WITH USE OF OTHER NONOPIOIDS FOR CHRONIC PAIN. Capsacian associated with application site pain; cannabis use associated with dizziness and large increases in withdrawal due to adverse events.
CONCLUSIONS - NONOPIOIDS FOR CHRONIC PAIN. Few studies avaialable on long-term use; short-term studies considered low to moderate quality.
CONCLUSIONS - NONOPIOIDS FOR CHRONIC PAIN. NSAIDs are effective for short-term relief of pain, functional improvement in arthropathies but are associated with CV, hepatic, and GI AEs.
