Nonopioid versus opioid agents for chronic neuropathic pain, rheumatoid arthritis pain, cancer pain and low back pain

Pain Manag. 2019 Mar 1;9(2):205-216. doi: 10.2217/pmt-2018-0052. Epub 2019 Jan 25.


Chronic pain continues to be a major health issue throughout the world and a huge economic burden for nations around the world. While the use of opioids does have risks, they are still widely used by clinicians as a treatment option for various chronic pain conditions. This review explores and compares the efficacy and safety of opioid and nonopioid agents for the following commonly encountered chronic pain conditions: neuropathic pain, rheumatoid arthritis joint pain, cancer pain and low back pain. Our findings demonstrate that while there are several nonopioid pharmacologic options that are clinically effective, opioids maintain a role in the treatment of certain chronic pain conditions and should continue to have an important place in the armamentarium of clinicians.

Keywords: cancer pain; inflammatory pain; low back pain; neuropathic pain; opioids; rheumatologic pain.

Publication types

  • Review

MeSH terms

  • Analgesics, Non-Narcotic / therapeutic use*
  • Analgesics, Opioid / therapeutic use*
  • Arthritis, Rheumatoid / complications
  • Cancer Pain / drug therapy
  • Chronic Pain / drug therapy
  • Humans
  • Low Back Pain / drug therapy
  • Neuralgia / drug therapy
  • Pain / drug therapy*
  • Pain Management / methods
  • Treatment Outcome


  • Analgesics, Non-Narcotic
  • Analgesics, Opioid