Non-opioid pain relief outperforms opioids for chronic pain: Study

Opioids were shown to have no significant advantage in treating chronic pain over non-opioid drugs in a year of patient observation, according to a study evaluating the effectiveness of often-prescribed medications at the forefront of the U.S. drug crisis.

“The real gap here is that there were no previous studies that did any kind of long-term comparison between opioids and other types of medications for chronic pain,” lead researcher Dr. Erin Krebs said in an interview with The Washington Times.

“The question is, if I take something for a year or longer, are opioids going to work better than other medications that are available to me? This is the first study that looked at that relevant question,” said Dr. Krebs, a physician with the Minneapolis Veterans Affairs Health Care System.

The study, which was published Tuesday in the Journal of the American Medical Association, followed 240 patients from Veterans Affairs primary health clinics who complained of chronic pain in the back, knee or hip or from osteoarthritis.

Participants were randomly assigned to an opioid or non-opioid regimen and closely followed for a year.

The participants were rated on a variety of measures of how the medications affected their pain and daily lives, including pain intensity, side effects and quality of life.

Opioids included morphine, oxycodone and a combination of hydrocodone and acetaminophen. Patients on the non-opioid regimen tried an average of four medications. These included a use or combination of medications such as acetaminophen; non-steroidal, anti-inflammatory drugs; topical medications; and prescription non-opioid nerve and pain medications.

Overall, both groups did not significantly differ in pain-related function over the course of a year. The ability to participate in daily activities improved equally for both groups.

However, pain intensity over the course of a year was significantly better in the non-opioid group.

On a scale of zero to 10, where higher scores equal worse function or pain intensity, opioid groups registered a pain severity of 4.0 while the non-opioid group was at 3.5.

“When I talked to other physicians, I think the thing that people are most surprised about is that secondary finding — that non-opioids decreased pain intensity more than the opioids did over time,” Dr. Krebs said.

Not surprisingly, the opioid group reported more “medicated-related symptoms,” although side effects weren’t specified. Opioids can cause lethargy, constipation and nausea, and more serious problems like accidental overdose or addiction.

“In this study, which we monitored people very closely, we try to avoid any of those outcomes, and we are happy to report none of those very serious outcomes of opioids,” Dr. Krebs said.

The nation’s opioid crisis is a staggering list of record-setting statistics.

An estimated 42,000 people died from overdoses related to opioids in 2016, according to the Centers for Disease Control and Prevention, and emergency room visits for opioid overdoes rose 30 percent in all parts of the U.S. from July 2016 to September 2017, a number that is likely underreported.

A number of factors have contributed to the opioid crisis in realms of legal and illegal activity. The powerful painkillers were overprescribed and were exploited by criminal networks.

The number of prescription opioids sold to pharmacies, doctors’ offices and hospitals nearly quadrupled from 1999 to 2010, according to the CDC, although the number of people complaining of chronic pain did not change.

The 2012 National Health Interview Survey found that an estimated 25.3 million U.S. adults (about 11.2 percent) had pain every day for the previous three months and nearly 40 million adults (17.6 percent) had severe pain.

In 2013 specifically, providers wrote nearly a quarter-billion opioid prescriptions, “enough for every American adult to have their own bottle of pills,” the CDC said on its website.

Guidelines for treating back pain and arthritis pain are exercise and rehabilitative therapy, Dr. Krebs said, but medication is often prescribed to help people participate in exercise programs or cope during bad days.

“It has been over the past 20 years fairly common practice that if someone doesn’t respond to medicine like acetaminophen or ibuprofen, to start them on opioids and treat them with opioids for potentially many years,” said Dr. Krebs, a general internist who is also the women’s health medical director for the Minneapolis VA.

The participants in the JAMA study were mostly male with an average age of 58 — not the typical profile of an opioid abuser.

Many drug injection users, in particular heroin addicts, have reported that their initiations with opioids were either as prescriptions for themselves, family members or friends.

Finding alternative solutions to treat pain, and chronic pain in particular, without opioids is one of many solutions researchers are considering to combat the crisis.