Opioids Not Best Option for Back Pain, Arthritis, Study Finds
Risky opioids are no better at controlling chronic back or arthritis pain than non-opioid drugs, including Tylenol or Motrin, new research finds.
With opioid overdose deaths rising in the United States, the findings suggest addictive medications like oxycodone (OxyContin) or morphine don't have to be the first choice against crippling arthritis pain or chronic backache.
"We found that opioids had no advantages over non-opioid medications for pain, function or quality of life in patients with low back pain and osteoarthritis pain," said study lead author Dr. Erin Krebs.
"This is important information for physicians to share with patients who are considering opioids," added Krebs. She's an investigator with the Minneapolis VA Center for Chronic Disease Outcomes Research.
Not only does the study suggest switching to opioids probably won't help, but Krebs said the prescription painkillers will probably cause unpleasant side effects.
"Instead, they should consider trying other non-opioid medications or non-medication treatments," Krebs suggested.
Long-term back pain hampers 26 million Americans aged 20 to 64, the American Academy of Pain Medicine has found. And roughly 30 million adults have pain from osteoarthritis, the wear-and-tear form of the disease, according to the U.S. Centers for Disease Control and Prevention.
In general, patients with chronic back or arthritis pain should first seek relief through exercise and rehabilitation therapies, said Krebs, who is also an associate professor of medicine at the University of Minnesota.
That's because opioid medications, while promising significant pain control, come with substantial risks.
"The main harms are accidental death, addiction and physical dependence," Krebs explained. "Everyone who takes opioids -- even those who do not misuse them -- is at risk for these serious harms."
To compare the effectiveness of different means of pain relief, the new investigation enrolled 240 adults, average age 58, from June 2013 through 2015. All were receiving care for moderate to severe chronic back pain, or hip or knee arthritis pain.
None of the study participants had taken opioids on a long-term basis, the researchers noted.
After enrollment, half were randomly assigned to receive a year of opioid treatment. Depending on "careful trial and error," Krebs said, this variously included morphine, hydrocodone/acetaminophen (Vicodin), oxycodone, and fentanyl patches. Daily dosages were restricted to 100 morphine-equivalent milligrams.
The non-opioid group received other pain relievers, including acetaminophen (Tylenol), and nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin) and naproxen (Aleve).
Over time, some patients in the non-opioid group were also offered prescription drugs, including amitriptyline or gabapentin, or topical analgesics such as lidocaine. In cases where nothing else worked, they were additionally prescribed nerve pain medications, such as duloxetine (Cymbalta) or pregabalin (Lyrica), or the narcotic tramadol (Ultram).
One year out, investigators determined that the two groups differed very little in terms of their ability to walk, work or sleep without pain.
The non-opioid group fared "significantly better" in terms of pain intensity compared with the opioid group, and experienced "fewer bothersome side effects," Krebs said.
Dr. David Katz is director of the Yale University Prevention Research Center. He said that for treating long-term musculoskeletal pain, "use of opioids is both ineffective and ill-advised."
"Anyone who has undergone surgery -- and I have a number of times -- certainly knows the value of opioid analgesia. When pain is acute and truly overwhelming, potent narcotics work, and essentially nothing else does," he said.
"But the value of opioids fades quickly over time, and the liabilities increase," Katz explained. "So an informed approach would tend to be very short-term use of opioids, when pain is most intense, with early and explicit plans to transition to alternatives."
Katz agreed with Krebs that non-medicinal "holistic approaches to pain management, often involving team care, tend to be best" for controlling chronic pain.
"There are many ways to treat pain that don't involve drugs at all," Katz added.
The report was published in the March 6 issue of the Journal of the American Medical Association.
There's more on chronic pain at U.S. National Institute of Neurological Disorders and Stroke.
SOURCES: Erin E. Krebs, M.D., M.P.H., medical director, women's health, Minneapolis VA Health Care System, and core investigator, Minneapolis VA Center for Chronic Disease Outcomes Research, and associate professor, medicine, University of Minnesota, Minneapolis; David Katz, M.D., MPH, director, Yale University Prevention Research Center, New Haven, Conn.; March 6, 2018, Journal of the American Medical Association