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Updated: Mar 2, 2026

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Tolerability of Opioid Analgesia for Chronic Pain: A Network Meta-Analysis

Zengdong Meng1, Jing Yu2, Michael Acuff3

  • 1Department of Orthopaedics, First People's Hospital of YunNan Province, YunNan, P.R. China.

Scientific Reports
|May 19, 2017
PubMed

Insights

This network meta-analysis found tapentadol and oxycodone-naloxone offer superior tolerability for chronic pain management. These opioid analgesics demonstrated fewer adverse events, less constipation, and lower withdrawal rates compared to other options.

Area of Science:

  • Pharmacology
  • Clinical Medicine
  • Pain Management

Background:

  • Opioid analgesics are widely used for chronic pain.
  • Concerns exist regarding their tolerability and adverse event profiles.
  • Comparative effectiveness data on different opioids is crucial for clinical decision-making.

Purpose of the Study:

  • To evaluate and compare the tolerability of various opioid analgesics for chronic pain management.
  • To synthesize evidence from randomized-controlled trials using network meta-analysis.
  • To identify opioid treatments with favorable safety and satisfaction profiles.

Main Methods:

  • A systematic database search identified randomized-controlled trials comparing two or more opioid analgesics.
  • Bayesian network meta-analyses (NMAs) were conducted to pool direct and indirect treatment comparisons.
  • Key endpoints included adverse events, constipation, trial withdrawal rates, and patient satisfaction.

Main Results:

  • Tapentadol ranked highest for overall tolerability, showing lower incidence of adverse events and constipation, and the least trial withdrawal.
  • Oxycodone-naloxone combination demonstrated good tolerability and low withdrawal rates.
  • Patient satisfaction was highest with oxycodone-naloxone, followed by fentanyl and tapentadol.

Conclusions:

  • Tapentadol and oxycodone-naloxone exhibit superior tolerability compared to other opioids for chronic pain.
  • These agents are associated with reduced adverse events, constipation, and trial withdrawal.
  • Improved tolerability and patient satisfaction support the use of tapentadol and oxycodone-naloxone in chronic pain management.

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