Finally, proof: opioids are no better than Tylenol for treating some chronic pain

As of 2016, 67 prescriptions were being written for every 100 Americans. Yet a high-quality randomized controlled trial was just published showing opioids work no better than non-opioids for chronic back pain and hip or knee osteoarthritis. Angie Wang

 

A first-of-its-kind study compared opioids to non-opioid drugs in patients with persistent back pain or hip or knee osteoarthritis. Its results are devastating.

 

Long before opioids snowballed into one of the worst public health crises in American history, Dr. Erin Krebs suspected there might be a problem.

As a medical fellow in North Carolina in 2004, Krebs noticed many of her patients were on prescription opioids like OxyContin — now well known to increase the risk of addiction and death — for common ailments like low back pain and arthritis. Even after patients took the drugs for months or years, however, Krebs noticed they weren’t helping.

So she looked to the medical literature to find studies about long-term opioid use — and there weren’t any. Most trials ran for no more than eight to 12 weeks and focused on the rather useless question of whether opioids performed better than no treatment at all.

Today, opioids are still prescribed at an astoundingly high rate. But thanks to Krebs, now a researcher at the Minneapolis VA Center and an associate professor of medicine at the University of Minnesota, doctors and patients will finally have a high-quality clinical trial that answers the rather simple question she’s been asking herself for more than a decade: Do opioids help patients with chronic pain in the long run? Are they worth all that risk?

The answer, according to her newly published JAMA study, is a resounding “no.”

Krebs is the lead author on the first randomized trial, comparing chronic pain patients on prescription opioids (like morphine, hydrocodone, and oxycodone) to patients on non-opioid painkillers (like acetaminophen or Tylenol, naproxen, or meloxicam), measuring their pain intensity and function over the course of a year.

The striking result was that the patients on opioids did no better than those taking the opioid alternatives — despite the much higher risk profile of opioids. At one year, the opioid takers even reported being in slightly more pain compared to the non-opioid group.

“I think this is going to shake things up,” said Roger Chou, a professor at Oregon Health and Science University who was not involved in the research. “The belief has always been opioids are the most effective pain medicine, certainly for acute pain and even for chronic pain. This [study] turns that on the head.”

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