Short- or Long-Acting Opioids?
Should short-acting or long-acting opioids be used chronically for chronic pain?
Dr. Chou: Although long-acting, round-the-clock opioids have often been suggested for treatment of chronic pain, there is no evidence that they are superior to short-acting or as-needed dosing. Potential benefits of long-acting, round-the-clock opioids are fewer peaks and troughs that in theory might increase the risk for addiction or withdrawal, and more sustained pain control. However, long-acting, round-the-clock opioids also are likely to induce tolerance and probably have contributed to the trends toward use of higher doses. No study has shown that long-acting opioids are safer than short-acting opioids or more effective for pain relief.
The bottom line is that it's probably OK to use either; if a patient is doing fine on a short-acting opioid, there is no compelling reason to switch him or her to a long-acting opioid, and vice versa.
Dr. Argoff: Despite their use and claims of the benefits of long-acting opioids, not a single published study has demonstrated that patients with chronic pain experience greater relief with long-acting opioids compared with short-acting. In fact, at least one head-to-head study demonstrated the opposite conclusion. Each of these broad types of opioid therapies may play a role in the successful management of a specific person's specific chronic painful condition. We need to work with a patient to understand what regimen may be optimal for that person.