Objective

Opioids are effective analgesics with notable limitations which may include; side effects, possible dependence and tolerance, exposure to the risk of opioid use disorder, and potentially life-threatening respiratory depression.  The objective was to evaluate the safety and efficacy of nonopioids, as monotherapy or in combination with opioids, for both acute and chronic pain conditions.

Methods

This was a narrative review that involved a literature search of relevant recent clinical trials (last 5 years). A total of 32 clinical studies were retrieved and included.

Results

In the dental pain model, musculoskeletal pain model, and other acute conditions, nonopioids provided effective analgesia with few or no side effects. In postoperative pain, combination therapy using a small amount of opioid with a larger amount of nonopioid analgesic was effective in treating pain and resulted in a lower cumulative consumption of opioids. Long-term analgesia for chronic noncancer pain is controversial although, opioids such as tapentadol or a combination product may be appropriate for selected patients.

Conclusion

Nonopioids can often be used for acute and chronic pain conditions on their own, or in combination with opioids. In general, nonopioids are associated with fewer adverse events.