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VA study: Opioids not better at reducing chronic pain

09 March 2018

Acetaminophen, or brand name paracetamol, was used as the non-opioid medication while the other pain-control regiment included morphine, oxycodone, or a combination of hydrocodone and acetaminophen.

"Overall, opioids did not demonstrate any advantage over nonopioid medications that could potentially outweigh their greater risk of harms", wrote the team led by Dr. Erin Krebs of the Minneapolis Veterans Affairs Health Care System's Center for Chronic Disease Outcomes Research.

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?

The findings cast doubt on the medical community's "standard approach" of using opioids to manage chronic musculoskeletal pain, the researchers found.

About 42,000 drug overdose deaths in the United States in 2016 involved opioids, including prescription painkillers, heroin and fentanyl.

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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.

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.

Researchers followed 240 people being treated at a VA hospital in Minneapolis for serious, chronic pain for over a year; most of the study participants were men.

A report released Tuesday by the Centers for Disease Control and Prevention found emergency rooms saw a big jump in overdoses from opioids a year ago.

Also, the opioid group reported twice the average level of adverse medication-related symptoms than the nonopioid group - with a 1.8 on a 19-point symptom scale compared to the nonopioid group's 0.9.

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"We found at the beginning of the study that patients who were enrolled really thought that opioids were far more effective than non-opioid medications", she says.

The study concluded that prescription opioids were "not superior" to treatment with OTC medications like acetaminophen in improving pain-related function over the period of a year, saying the results do not support prescription of opioid medications for moderate to severe back pain, or hip/knee osteoarthritis pain.

These patients explained what people should keep in mind about chronic pain when reading the study.

The study was funded by the Department of Veterans Affairs.

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VA study: Opioids not better at reducing chronic pain