Minneapolis VA Health Care System
Opioids Not Better than Non-opioid Pain Medication
Researchers from the Minneapolis VA Health Care System have found that opioid medications achieve no better results than non-opioid medications for long-term treatment of chronic back pain and osteoarthritis pain. The study was presented at the Society of General Internal Medicine on April 21.
In a randomized study of 240 Veterans, the research showed similar outcomes in pain interference with activities and overall adverse symptoms in both arms of the study. Pain intensity and medication-related adverse symptoms were slightly better in the non-opioid arm after 12 months of therapy.
"Opioids are perceived as strong pain relievers, but our data showed no benefits of opioid therapy over non-opioid medication therapy for pain," said Erin Krebs, MD, the chief author, who holds appointments at the Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, and the University of Minnesota. "We already knew that opioids carry more risks of serious harms for patients. These new findings support the CDC recommendation that non-opioid therapies are preferred over opioids for long-term pain treatment."
The study was titled Strategies for Prescribing Analgesics Comparative Effectiveness (SPACE). According to researchers, it was the first randomized trial to evaluate the effectiveness of long-term opioid therapy.
Patients were eligible if they were seen in VA primary care clinics with moderate-severe chronic back pain or hip/knee osteoarthritis pain despite analgesic use. Participants were randomized to 1 of 2 active treatment arms—opioid therapy or non-opioid medication therapy—using a computer to conceal allocation.
Multiple FDA-approved drugs were included in each arm. Within each arm, medications were adjusted to target pain and functional goals. Masked assessors collected outcomes at 3, 6, 9, and 12 months.
Over 12 months, pain interference with activities improved in both arms. Pain intensity improved more in the non-opioid arm. The overall adverse symptom count did not differ between arms, but patients in the opioid group reported more adverse symptoms related to medications