Opioids No Better Than Common Painkillers for Chronic Pain
A recently published government-funded study is among the first long-term studies to compare the efficacy of opioids to common painkillers in patients with chronic pain and arthritis.
It was found that after one year of treatment, opioids weren't any better at improving pain related to daily functioning, specifically, the ability to sleep and work. It was also found that opioids were slightly inferior at controlling pain intensity and patients on them reported many more side effects, according to the results published in the Journal of the American Medical Association.
"The fact that opioids did worse is really pretty astounding," said Roger Chou, a co-author of Centers for Disease Control and Prevention guidelines on opioid use for chronic pain, who was not involved in the recent study. "It calls into question our beliefs about the benefits of opioids."
These findings run counter to years of medical practice where opioids have been prescribed to millions of patients for chronic pain over the years, even though data on their long-term effectiveness was lacking. While doctors are pulling back on opioid prescription, it hasn't yet stemmed opioid abuse and an overdose crisis that kills tens of thousands of Americans each year. The study hands another blow to opioid manufacturers, some of which are already facing hundreds of lawsuits filed by cities and counties over their role in the opioid crisis.
Lead author of the study, Erin Krebs, and her colleagues at the Minneapolis Veterans Affairs Health Care System, randomly assigned 240 patients with chronic back pain, or hip or knee arthritis, to be treated either with opioid painkillers like morphine and oxycodone, or non-opioid medicines like naproxen, or topical analgesics such as lidocaine.
After one year, about 60 percent of patients in each group experienced significant improvements in their ability to perform daily functions without pain interfering. But pain intensity improved significantly in just 41 percent of patients in the opioid group, compared with 54 percent in the non-opioid group, said Krebs. Patients taking opioids reported experiencing twice as many side effects. The results will be "surprising for a lot of people," Krebs said. "Opioids have this reputation as powerful painkillers and I don't think it is well deserved, at least for chronic pain."
While opioids provide potent relief for acute pain, that doesn't necessarily translate to a chronic pain situation, where the pain often becomes disassociated from the original injury. Long-term studies haven't been required for regulatory approval of their sales, and drug makers have had no incentive do any. Most controlled studies of opioids lasted less than six weeks. This is the first long-term study on opiods and it demonstrates you do not need opioids for these chronic pain conditions, that common drugs are just as good.