Minneapolis VA Health Care System
Opioids Don't Beat Other Meds for Chronic Pain
A yearlong study published in the March 6, 2018, issue of the Journal of the American Medical Association by a team of Minneapolis VA researchers offers strong evidence against using prescription opioids for chronic pain.
The study involved 240 patients suffering chronic pain from 62 Minneapolis VA primary care clinics who were assigned to use generic versions of opioids or nonopioids for a year. Follow-up ended in 2016.
Chronic pain was defined as nearly-daily pain for 6 or more months.
The results likely will surprise many people "because opioids have this reputation as being really powerful painkillers, and that is not what we found," said lead author Dr. Erin Krebs, a physician and researcher with the Minneapolis Veterans Affairs Health Care System’s Center for Chronic Disease Outcome Research.
In patients with chronic back aches or hip or knee arthritis, opioids worked no better than over-the-counter drugs or other nonopioids at reducing problems with walking or sleeping. And they provided slightly less pain relief.
Opioids tested included generic Vicodin, oxycodone or fentanyl patches — although few patients needed the most potent opioids. Nonopioids included generic Tylenol, ibuprofen and prescription pills for nerve or muscle pain. The study randomly assigned patients to take opioids or other painkillers. That's the gold standard design for research.
Among the 240 patients, 234 completed the trial. There was no significant difference in mean pain-related function over 12 months between the two groups, but nonopioid patients reported a slightly better score. Pain intensity was also better — this time, significantly so — for the nonopioid group over 12 months.
Study results support federal guidelines against routine use of opioids for chronic pain.
In 2016, U.S. government guidelines said opioids are not the preferred treatment for chronic pain. Guidelines recommend non-drug treatment or nonopioid painkillers instead. Opioids should only be used if other methods don't work for chronic pain, the guidelines recommend.
About 42,000 drug overdose deaths in the U.S. in 2016 involved opioids, including prescription painkillers, heroin and fentanyl. Many people get hooked while taking opioids prescribed for injuries or other short-term pain and move on to cheaper, more accessible illicit drugs like heroin.
According to Krebs, the strongest evidence from other studies shows that physical therapy, exercise or rehabilitation therapy works best for chronic pain. And she said noted that there are a variety of nonopioid drugs to try if one type doesn't work.
STORY BASED ON JAMA NEWS RELEASE AND NEWS MEDIA REPORTS