研究人员说，阿片类药物可有效缓解短期疼痛，但对于长期缓解疼痛并没有更好的选择。另外，阿片类药物具有更多的副作用。

可能是时候重新考虑处方阿片类药物以缓解慢性疼痛了。

阿片类药物止痛药在一年的时间内没有表现出与非阿片类药物治疗慢性背部和关节炎疼痛的优势，但它们确实导致了更多的副作用。 study published today in the Journal of the American Medical Association (JAMA).

“We already knew opioids were more dangerous than other treatment options because they put people at risk for accidental death and addiction. This study shows that extra risk doesn’t come with any extra benefit,” Dr. Erin Krebs, lead study author and women’s health medical director at the Minneapolis VA Health Care System, told Healthline.

The study recruited 240 individuals with chronic pain. One group was given an opioid pain medication while the other was treated with either acetaminophen or a nonsteroidal anti-inflammatory drug.

研究人员研究了一些结果：与疼痛相关的功能，疼痛影响生活质量的程度（日常活动，工作和睡眠之类的东西）；疼痛强度，疼痛的实际严重程度；和药物的不利副作用。

“以前的随机对照试验是短期的（少于16周），并将阿片类药物与安慰剂进行了比较。这项研究很重要，因为它是一项随机对照试验（科学研究的最高水平），是长期的（12个月），并将阿片类药物与现实的替代治疗（非阿片类药物）进行了比较。”

“阿片类药物在干扰生活活动方面没有更好的选择。此外，与阿片类药物相比，非阿片类药物的疼痛强度更大，副作用更少。”她说。

克雷布斯和她的团队使用了简短的疼痛清单（BPI）量表。这是一个简单的1到10个评分系统，其中1个最不重要，而10个最多。

With it, the researchers were able to compare pain intensity with people using opioid and non-opioid medications.

对于与疼痛相关的功能，两组几乎完全相同。阿片类药物组的测量为3.3，而非阿片类药物组为3.4。

For pain intensity, the non-opioid group measured 3.5 compared with 4.0 for the opioid group.

此外，阿片类药物组的成员有更多与药物直接相关的症状。

These symptoms included problems with sleep, gastrointestinal issues, sexual dysfunction, muscle aches, sweating, and fatigue.

Researchers also evaluated for potential misuse of opioids. “No deaths, ‘doctor-shopping’ [when a patient visits multiple doctors to get a prescription], diversion, or opioid use disorder diagnoses were detected,” they reported.

However, says Krebs, the sample size of their study isn’t indicative of those problems on a national scale.

“The best way to study the risk of these serious, less frequent harms is to look at what happens in the real world to tens of thousands of people treated with opioids. Other studies have done this, which is how we know that higher opioid doses and longer-term use of opioids increase the risk of dying or becoming addicted,” she said.

Rates of opioid misuse, addiction, and opioid-related deaths have skyrocketed in recent years in the United States. In 2016, the Centers for Disease Control and Prevention (CDC) reported there were64,000次药物过量死亡在美国。在芬太尼等合成阿片类药物中，最大的增加。

医疗保健专家和立法者越来越批评处方阿片类药物在创造当前流行中的作用。

Last month, Purdue Pharmaceuticals — the company behind OxyContin, a popular prescription opioid — announced they’d停止药物向医生营销。此后，该公司已解雇了200名销售员工，大约是该公司美国销售人员的一半。

As a pain therapy, new research, including Krebs’ work, suggests that opioids — while effective for short-term pain management — aren’t always ideal for chronic pain.

The CDC and other regulatory agencies are, in some cases, now trying to phase out long-term opioid prescriptions for chronic pain.

The CDC’s current guidelines have shifted in recent years away from precautions over “high-risk patients” to instead focus on the potential risk for opioid use disorder and other serious side effects in all individuals using opioids for chronic pain.

他们的建议包括使用最低剂量，使用即时释放的阿片类药物而不是扩展释放形式开始治疗，并定期与患者进行跟进，以讨论持续使用阿片类药物的风险和好处。

“阿片类药物对于在生命末期的疼痛以及由于严重疾病，创伤或手术而导致的严重疼痛的短期治疗仍然是无价的。这些是未受到质疑的阿片类药物的传统用途。”克雷布斯说。

“[They] have never been proven to be better than standard pain medications or nonmedication treatments for most common pain problems, including chronic back pain and arthritis pain… If opioids are prescribed, we should recognize that they have serious risks for anyone who takes them — not just those who misuse them — and be much more careful in our prescribing and follow-up,” she said.