Prescription opioid abuse has triggered national alarm, in part because the drugs have been linked to a rapid increase in drug overdose deaths - either because people misused the prescription drugs themselves, or because the painkillers served as gateway drugs that led people to try illicit drugs such as heroin. While there are many conditions that can cause chronic pain, like autoimmune diseases, Ehlers-Danlos syndrome and fibromyalgia, only back pain and hip or knee pain from osteoarthritis were included in the study. The participants were then asked to rate their pain every three months, on two scales: intensity and functionality (how easy it is to go about your day-to-day life).
The trial - Strategies for Prescribing Analgesics Comparative Effectiveness, or SPACE - enrolled patients who were treated by the Minneapolis VA. Patients were randomly assigned to an opioid or non-opioid group (participants knew which group they were in and what medications they were taking). For a year, one group was treated with nonopioid medications like like acetaminophen, or Tylenol, while the other was treated with opioids, including morphine, oxycodone, and hydrocodone.
Patients reported changes in function or pain on questionnaires. But after nine months, patients in the opioid group reported no further progress in reducing the intensity of their pain, while patients in the comparison group showed continued improvement.
Unsurprisingly, there were significantly more medication-related symptoms in the opioid group than in those who took Tylenol or NSAIDs, but there was no difference between the groups in adverse outcomes.
However, the findings should prompt doctors to reconsider the use of opioids as a first-line treatment for chronic musculoskeletal pain, they wrote. The nonopioid group started on acetaminophen, ibuprofen or similar anti-inflammatory drugs.
For the study, a team of researchers recruited patients seeking pain treatment for moderate to severe chronic back pain or hip or knee osteoarthritis pain at Veterans Affairs primary care clinics.
The study was funded by the Department of Veterans Affairs.
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