Do People With Chronic Pain Function Better Without Opioid Drugs?

Those with neuropathic pain may use opioid drugs to manage the shooting, burning pain and numbness that is associated with this complex and chronic pain state, but they should not be relied upon to improve physical functioning, according to new research.

Neuropathic pain is usually accompanied by a tissue injury and damaged nerve fibers, which can result in a change in nerve function both at and around the site of the injury.

The study found that opioid pain relievers such as morphine and hydrocodone, which work by reducing the number of pain signals sent by the nervous system and the brain’s reaction to those pain signals, did not improve physical functioning and disability among patients with neuropathic pain.

“We studied patients with neuropathic pain from nerve injuries such as diabetic neuropathy and pinched nerves, and the ones who weren’t prescribed any opioids had statistically lower disability and higher physical functioning scores,” said Geoff Bostick, the study’s lead author, in a statement.

The study, published in Pain Medicine, analyzed data from 789 patients who provided baseline measures of self-reported function, once prior to the study and again six and twelve months after treatment. Overall, people who took opioids for neuropathic pain saw no improvements in physical functioning compared with those being treated with other therapies.

Bostick noted that pain relief does not guarantee improved function in the affected area. “Even though opioid medications can be a powerful pain killer, it does not necessarily mean improved function will follow—pain is not the only factor in determining function,” said Bostick.

This is not to discount the role of opioid drugs in the treatment of pain, but Bostick emphasized that improving movement and function should be as important (if not more) as pain relief. “Pain is very complex, and people experience pain at very different levels,” he said. “Opioids can help people with severe pain be more comfortable, but if they are not also facilitating improved function, the impact of these medications on quality of life should be questioned.”

Physical therapy can be difficult, but it is important to promote movement despite the pain, said Bostick. Working through the pain of improving physical function should be a gradual process. Bostick tells patients to “walk until they are at 50% of their tolerance ... and stop before the pain gets too bad.” Each week, the walking time is gradually increased. Over time, tolerance will slowly increase and so will physical function.