High-Dose Opioids

(eg. morphine, oxycodone)
11%

Improve with treatment

29%

Improve with control

60%

Do not Improve

What does improve mean?

An example of a 30% reduction in pain scores is a decrease from 6 to 4 on a 10 point pain scale

0
1
2
3
4
5
6
7
8
9
10

How many people will improve?

40%

Improvement by treatment or placebo

60%

No Improvement

High-Dose Opioids Harms

Constipation
24%
7% (placebo)
Somnolence/Fatigue
27%
8% (placebo)
Nausea
25%
8% (placebo)
Dizziness
18%
8% (placebo)
Stopped due to side effects
14%
6% (placebo)

Other Considerations

  • Last option due to risk of dependence, side-effects, and long-term serious harms
  • If absolutely needed, doses should be kept ≤ 90 mg/day of morphine equivalents
  • Should be used short-term
  • Risk of addiction with long term use
  • Side effects are more common in older patients and may lead to falls
  • Approximate cost (CAD) for 30-day supply (without dispensing fee): $14 to $30

Looking for further details?

Neuropathic Pain

Why doesn’t this calculator cover all treatment options available?

This online calculator does not cover all treatment options available for neuropathic pain. We only included the medication treatments that had the highest quality evidence. A healthcare provider may consider other options not listed in this calculator to manage symptoms, depending on specific needs.

Where can I find the evidence used to create this calculator?

The data used for this calculator can be found within the Neuropathic Pain Systematic Review

Additional tools created with this data can be found at Neuropathic Pain Decision Aid

What is neuropathic pain?1

1. Taylor D. Neuropathic Pain. https://www.emedicinehealth.com/neuropathic_pain_nerve_pain/page2_em.htm. Updated November 2017. Accessed January 13, 2018.

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2. Moore RA, Derry S, Aldington D, Cole P, Wiffen PJ. Amitriptyline for neuropathic pain in adults. Cochrane Database Syst Rev. 2015 Jul 6;(7):CD008242.

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3. Watson P. Neuropathic Pain. https://www-e-therapeutics-ca.login.ezproxy.library.ualberta.ca/search. Updated May 2017. Accessed January 13, 2018.

Neuropathic pain is a type of pain generally caused by damaged nerves in the body. This damage may have resulted from a medical condition like diabetes, exposure to a toxin, alcohol, or previous surgery. Because the nerves are damaged, pain is not felt the same way as other types of pain.

Unlike pain from an injury, neuropathic pain can happen from normal, light touch, such as from clothing brushing against skin. This leads to feelings of pain that can be described as “burning”, “shooting” or “tingling”. Every person experiences neuropathic pain differently. Neuropathic pain can feel constant, come and go, or it can change in intensity.

Can neuropathic pain be treated or cured?3

3. Watson P. Neuropathic Pain. https://www-e-therapeutics-ca.login.ezproxy.library.ualberta.ca/search. Updated May 2017. Accessed January 13, 2018.

In most cases, neuropathic pain cannot be cured. However, the pain can be managed.

The main goal of treating neuropathic pain is reducing pain to a realistic level that allows a patient to live comfortably. We are rarely able to eliminate the pain entirely.