Chronic pain
Pain persisting beyond 3 months or beyond expected healing. Includes back pain, osteoarthritis, fibromyalgia, neuropathic pain, and others. Per the CDC 2022 Clinical Practice Guideline and SED-SEMERGEN 2023, long-term opioids are not used as first-line therapy due to dependence risk and weak long-term efficacy. First-line: paracetamol, NSAIDs, physiotherapy, cognitive-behavioral therapy; for neuropathic pain – gabapentinoids, duloxetine, amitriptyline.
Also known as: Chronic non-cancer pain, Persistent pain
Drugs used for this condition
Marketing claims without evidence base
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
- DLidocaineNot recommended · Amide-type local anaesthetic and class Ib antiarrhythmic (systemic use, codes C01BB01 and N01BB02)Courses of intravenous lidocaine and lidocaine blocks get offered for chronic pain across a wide list: fibromyalgia, back pain, headache, pelvic pain. The Cochrane review of systemic local anaesthetics in neuropathic pain found that lidocaine beat placebo in trials and was no worse than comparator drugs, yet the effect was short, samples were small, and no trial showed lasting relief. The AEMPS Lidocaína Normon label carries no chronic pain indication. The risks with repeated dosing are not abstract: lidocaine accumulates when hepatic blood flow falls, and next to a beta blocker or a CYP1A2 inhibitor the concentration climbs further, with toxicity starting as numbness around the mouth and ringing in the ears. If a course of intravenous lidocaine was offered as treatment for chronic pain, consider seeking a second opinion.
- DOxycodoneNot recommended · Semi-synthetic opioid analgesic (μ-agonist)Long-term therapy of chronic non-cancer pain – osteoarthritis, back pain, fibromyalgia. In the 2000-2010s oxycodone was aggressively marketed as a safe long-term opioid, driving the US opioid epidemic with >600,000 deaths. Per CDC 2022 Clinical Practice Guideline and SED-SEMERGEN 2023, long-term opioids are not used as first or second-line for chronic non-cancer pain: 3-month efficacy matches placebo, addiction rate 8–12%, overdose risk rises beyond 50 morphine milligram equivalents. If oxycodone was prescribed for back pain over months, consider getting a second opinion and treatment-plan review.
- DTramadol + ParacetamolNot recommended · Fixed-dose combination: weak opioid with SNRI activity plus non-opioid analgesicLong-term therapy of chronic non-cancer pain – back pain, osteoarthritis, fibromyalgia. Often prescribed for months as a safe non-addictive opioid, but this marketing framing does not reflect the real profile. Per CDC 2022 Clinical Practice Guideline and SED-SEMERGEN 2023, long-term opioids are not used as first or second-line for non-cancer pain: efficacy at 3 months matches placebo while dependence and overdose risks remain. Tramadol causes dependence and fatal cases have been reported in CYP2D6 ultra-rapid metabolizers. If prescribed long-term for back pain or osteoarthritis, consider getting a second opinion and treatment-plan review.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit