Important Year-Long Chronic Pain Study Finds Opioid and Non-Opioid Painkillers  the Same

Important Year-Long Chronic Pain Study Finds Opioid and Non-Opioid Painkillers the Same

In spite of all the claims made by pharmaceutical companies, doctors, chronic pain patients and everyone else with a stake in the game, opioids are no better than non-opioid painkillers for most patients with chronic pain, when managed with understanding for each individual patient.

A landmark study comparing opioid and non-opioid painkillers found they were equally effective at treating chronic pain over an entire year for patients suffering from severe chronic back pain or pain from osteoarthritis of the hip or knee.

This study, published in the Journal of the American Medical Association, may not be the first to make such a comparison and suggest similar findings. And neither was it a particularly large study.

A welcome new reality

But it's being viewed by concerned physicians as the door to a welcome new reality in treating chronic pain, in part because it was so rigorously randomized and controlled, and because it was conducted for much longer than previous studies - for a year, compared to 12 weeks.

"Despite the widespread use of opioids for the management of chronic pain, as well as guidelines suggesting they are an appropriate therapy for chronic pain, there had been disconcertingly little evidence on the topic," wrote Pieter Cohen, MD, and Michael Hochman MD, MPH, in their article for MedPage Today. "The best studies were no longer than 12 weeks in duration and involved only a small number of subjects."

The new JAMA study is titled "Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain - The SPACE Randomized Clinical Trial."

The randomized clinical trial compared the effects of opioid vs non-opioid medications, over 12 months, on pain-related function, pain intensity, and adverse effects among Veterans Affairs patients with moderate to severe chronic back pain or hip or knee osteoarthritis pain.

"Treat to target strategy"

The trial involved 240 patients, randomized into the opioid or non-opioid group, and investigators tracked pain-related function for a full year.

Both the opioid and non-opioid medication therapy followed a "treat-to-target strategy" aiming for improved pain as well as function. Treat-to-target means that each group had its own prescribing strategy that included multiple medication options. In the opioid group, the first step was immediate-release morphine, oxycodone, or hydrocodone/acetaminophen. For the non-opioid group, the first step was acetaminophen (paracetamol) or a nonsteroidal anti-inflammatory drug. Medications were then changed, added, or adjusted within the assigned treatment group according to individual patient response.

Pain levels and functionality

The primary outcome for the study was pain-related function over 12 months, and the main secondary outcome was pain intensity. The primary adverse outcome was medication-related symptoms - drug side-effects or reactions.

The opioid vs non-opioid groups did not significantly differ on pain-related function over 12 months, the study found. Levels measured 3.4 for the opioid group and 3.3 for the non-opioid group. Pain intensity was significantly better in the non-opioid group over 12 months - a 4.0 for the opioid group and 3.5 for the non-opioid group.

As you might guess, adverse medication-related symptoms were "significantly more common" in the opioid group over 12 months - at 1.8, roughly double the 0.9 adverse side-effects of the non-opioid group.

The study authors' conclusions were clear and, for many physicians will be rather earth-shattering:

"Treatment with opioids was not superior to treatment with non-opioid medications for improving pain-related function over 12 months. Results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain."

Same results in the ER

Another JAMA study published last fall found that non-opioid therapy may be as effective as opioids in treating acute pain in the emergency room.

"With this information, coupled with growing evidence about the epidemic of opioid abuse, the role of opioids in pain management outside of the palliative setting is growing increasingly narrow," said Cohen and Hochman in MedPage Today. "Nevertheless, there remain millions of Americans who depend on opioids, and we must be compassionate in managing their care, even if we now know it is not an effective pain treatment strategy."

In the study described above, this kind of patient-centric strategy was key to making the system work. Carefully managing the pain medications individually for each patient, rather than a one-size-fits-all approach, was essential to a true scientific as well as practical result.

Here at Novus, we are fully devoted to tailoring every treatment to the needs of the individual patient. It's an essential part of the strategy that helps our patients get their lives back.

Start Your New Path to Sobriety Today!

    • Please enter your name.
    • This isn't a valid phone number.
    • Please enter your email address.
      This isn't a valid email address.
    • Please make a selection.
    • Please enter a message.