Monday, 19 March, 2018

Prescription opioids fail rigorous test for chronic pain

Study: Opioid treatment is not superior to non-opioid treatment for some pain Workers' comp and pain management experts discuss alternatives to opioids
Melissa Porter | 09 March, 2018, 05:51

At the end of 12 months, the opioid group scored an average 3.4 on the function scale, and the nonopioid group 3.3, an insignificant difference.

Krebs' study, published in the Journal of the American Medical Association on Tuesday, finds opioids are no better than non-opioid medications when it comes to treating patients with some of the most common types of chronic pain. "Results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain". Chronic pain management Dr. Erin Krebs and two other researchers working at the Veteran's Administration Medical Center in Minneapolis conducted a study on chronic disease outcomes.

The results likely will surprise many people "because opioids have this reputation as being really powerful painkillers, and that is not what we found", Krebs said.

By some measures, the people using non-opioid drugs such as Tylenol, ibuprofen and lidocaine experienced more pain relief than people using medications like morphine, Vicodin and oxycodone - though the differences weren't large enough to be considered statistically significant. 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. "It will likely change the approach to managing long-term back, hip and knee pain". Patients were randomly assigned to an opioid or non-opioid group (participants knew which group they were in and what medications they were taking). "Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain", JAMA. The mean patient age was 58.3 years old and 13 percent of participants were women. When the treatment was started, the opioid and non-opioid groups scored nearly exactly the same on both intensity and functionality. However, hospitalizations and emergency room visits to deal with pain medications were similar in both groups, as were rates of drug misuse. However, the average pain intensity dropped two points in the non-opioid group and slightly less in the opioid group.

So let's break down the study (you can read it here).

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 levels of pain were recorded throughout the year-long study and rated from 0-10, with people self-reporting their pain as being higher on the BPI scale meaning they were experiencing higher levels of pain/worse function.

The study was funded by the Department of Veterans Affairs.