Non-opioid pain relief outperforms opioids for chronic pain, study shows


That's the gold standard design for research.

When Dr. Erin Krebs was in medical school in the '90s, she was taught to avoid prescribing opioids long-term because the drugs were addictive.

When she looked for data on the efficacy of opioids, she was troubled to find that there were no longitudinal studies on the effects of taking opioid painkillers long term. The number of overdose deaths linked to prescription drugs like oxycodone and hydrocodone has increased by a factor of four since 1999, the CDC says.

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Except this wasn't the case: although patients were expecting opioids to be more effective, they weren't. All of the patients had pain in their backs, hips or knees for at least six months, and that pain was bad enough to interfere with their daily activities and enjoyment of life. He then split them into two groups, assigning half of them to receive opioids, and the other half to non-opioid drugs. "Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain", JAMA. The average age of participants was 58.3 and majority male, with 32 female participants.

All patients started with lower levels of pain medications and were able to "step up" their treatment as necessary.

Opioids tested included generic Vicodin, oxycodone or fentanyl patches although few patients needed the most potent opioids. However, the average pain intensity dropped two points in the non-opioid group and slightly less in the opioid group. Both groups started out with average pain and function scores of about 5.5 points. On a scale of 0 to 10, the average score was 3.4 for those on opioids and 3.3 for those who weren't. This was measured with a patient reported checklist. The one exception was anxiety, which improved more for those taking opioids.

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Unsurprisingly, there were significantly more medication-related symptoms in the opioid group than in those who took Tylenol or NSAIDs, but there was no difference between the groups in adverse outcomes. It is the first longitudinal study to examine the efficacy of opioids for chronic pain.

US government guidelines in 2016 said opioids are not the preferred treatment for chronic pain, and they recommend non-drug treatment or nonopioid painkillers instead.

The three asked the question: Does opioid medication produce better results in treating pain in patients specifically suffering from moderate to severe chronic back pain or hip/knee osteoathritis pain compared to nonopioid options?

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The results echo less rigorous studies and bolster guidelines against routine use of opioids for chronic pain.