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Doctors and patients should instead first try less risky and less expensive pain relievers, such as acetaminophen (the ingredient in Tylenol), non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin IB and generics), and naproxen (Aleve and generics), or non-opioid prescription pain medicines. Evidence indicates that these common painkillers used by millions of people at low doses everyday to treat mild aches and pains are often just as effective as opioids – and less risky – against chronic pain when used at somewhat higher doses, the report concludes. Chronic pain has many causes, including injuries that fail to heal properly, nerve damage from diseases, and aging joints. And sometimes it arises for no apparent physical reason. It’s also defined as any pain that lasts longer than three to six months. The report – written for consumers and available free at www.CRBestBuyDrugs.org – analyzes and compares 12 opioid medicines. It’s the 20th report in a series that helps consumers talk with their doctors about their medicines and find drugs that give them the best value for their health care dollar. Previous reports tackle drugs to treat high cholesterol, high blood pressure, depression, asthma, allergies, Alzheimer’s disease, insomnia, menopause, and migraine headaches. Opioids have long been controversial because they can be addictive and are prone to abuse and misuse as recreational drugs. When used by people not in pain, the drugs cause sedation, a sense of calm, and elation. Opioids like OxyContin, Vicodin, Demerol, Darvon, and Percocet have become household names primarily because of their link to abuse and misuse. At the same time, the opioids have sometimes been under-prescribed to treat people who genuinely need them because doctors fear misuse, the risk of addiction and other problems. “This is a one of the most challenging group of medicines to use wisely – for doctors and patients,” says Orly Avitzur, M.D. M.B.A, a neurologist and Medical Adviser to Consumers Union and Consumer Reports. “What this new report shows is that while the opioids have a role to play in treating some people with chronic pain, they should be used with extra caution and certainly should not be the first drug tried.” One reason for that, according to the report, is mounting evidence that links the long-term use of opioids to adverse effects. These include a decrease in sex hormones leading to both a loss of interest in sex and impaired sexual function; a decline in immune function; and an increase the body’s sensitivity to pain. These problems don’t appear to be permanent and will go away when use of the opioid is stopped. People who take opioids for longer periods also commonly build up a tolerance to them and thus require larger doses to achieve the same pain relief. This increases the risk of adverse effects and addiction. The report also notes that some kinds of chronic pain in particular – such as nerve pain, migraines, or fibromyalgia – are best treated with other types of drugs, not opioids. For example, a class of drugs called the triptans are often the best drugs to treat moderate to severe migraines. The report chooses four generic drugs as Best Buys for people who have chronic pain and whose doctors have concluded that an opioid is necessary. They are: • Codeine plus acetaminophen • Morphine extended release • Oxycodone extended release • Oxycodone with acetaminophen Lower-dose regimens of these drugs generally cost less than $150 a month, providing good value relative to other opioids. Higher-dose regimens are more expensive. The report advises consumers that there is no need to take the brand-name versions of these medicines, such as Tylenol #3 or #4, MS Contin, OxyContin, or Percocet. People who suffer from chronic pain should be sure to talk with their doctor about non-drug measures, too, the report urges. Several, including cognitive behavioral therapy, exercise, spinal manipulation, and physical rehab programs, have been shown to ease pain and/or improve quality of life. Consumer Reports Best Buy Drugs™ combines a review of the scientific evidence on the effectiveness and safety of medicines with pricing information. Every report is peer-reviewed by medical experts. The project is independently administered by Consumers Union and Consumer Reports with support from the Engelberg Foundation, a private philanthropy, and the National Library of Medicine. A copy of the report is available at http://www.consumerreports.org/health/best-buy-drugs/opioids.htm www.HealthNewsDigest.com Top of Page 
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