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Opioid painkillers — which have long been a staple in treating chronic pain — fared no better than nonopioid analgesics in easing back and osteoarthritis pain, according to a study published this week in the Journal of the American Medical Association. In fact, patients receiving nonopioid medications reported less pain intensity than those receiving opioids.
The randomized, controlled study is the first to directly compare the effectiveness of opioids, such as morphine and hydrocodone, with nonopioids such as acetaminophen, ibuprofen, and other nonsteroidal anti-inflammatory drugs (NSAIDs). The study comes in the midst of a worsening opioid crisis in the United States, as physicians and hospitals seek alternative methods of pain control.
The researchers recruited 240 patients from Veterans Affairs clinics for the study. The patients all were being treated for chronic back pain or osteoarthritis in the hip or knee, and randomly assigned to the opioid or nonopioid groups. Those in the opioid group were given drugs such as quick-release oxycodone, morphine, or hydrocodone; nonopioid patients received acetaminophen or other NSAIDs. Medications and dosages were adjusted and changed as needed, depending on patients’ symptoms.
Over the 12-month study period, patients rated pain severity on a scale of 0-10. The nonopioid group saw greater improvement in overall pain intensity vs. the opioid group – 3.5 vs. 4.0, respectively. Pain-related function saw no significant difference between groups: 3.4 in the opioid group, 3.3 in the nonopioid group. Opioid patients were more likely than nonopioid patients to experience side effects: 1.8, vs. 0.9, respectively.
“Treatment with opioids was not superior to treatment with nonopioid medications for improving pain-related function over 12 months,” the study authors concluded. “Results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain.”