Opioids don't outperform other medications for chronic pain

Millions of opioids have been taken by millions of patients dealing with back pain or osteoarthritis in hips and knees. But how effective are these prescriptions? Turns out, not all that great in long-term outcomes compared to nonopioid medications.

Research published online March 6 in the Journal of the American Medical Association featured a randomized trial of 240 patients to examine pain-related function after 12 months. Though a small study, the results show a need for more research on opioids and long-term pain management.

“Among patients with chronic back pain or hip or knee osteoarthritis pain, treatment with opioids compared with nonopioid medications did not result in significantly better pain-related function over 12 months,” wrote lead author Erin E. Krebs, MD, MPH, with the Minneapolis Veterans Affairs Health Care System, and colleagues. “Nonopioid treatment was associated with significantly better pain intensity, but the clinical importance of this finding is unclear; the magnitude was small (0.5 points on the 0-10 BPI severity scale) and was less than the minimal clinically important difference of 1.”

Researchers examined 240 patients from Minneapolis VA clinics with chronic back pain or knee or hip osteoarthritis pain that was moderate to severe despite analgesic treatments. Participants had a mean age of 58.3 years, with women accounting for 13 percent.

Using the 0-10-based Brief Pain Inventory (BPI) scale, Krebs and colleagues assessed participants at 12 months. Findings included:

  • Pain-related function was 3.4 for those who took opioids and 3.3 for the nonopioid group.
  • Pain intensity was significantly better in the nonopioid group (4.0) than the opioid population (3.5).
  • Adverse medication-related symptoms were more common in the opioid group (1.8 on the BPI scale) than those who took nonopioid medications (0.9).

“Treatment with opioids was not superior to treatment with nonopioid medications for improving pain-related function over 12 months,” the authors wrote. “Results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain.”

NPR and Kaiser Health News have reported on one person's story about transitioning from opioid-based pain medication.