Bottom Line: Opioid medications were not better at improving pain that interfered with activities such as walking, work and sleep over 12 months for patients with chronic back pain or hip or knee osteoarthritis pain compared to nonopioid medications.
Why The Research Is Interesting: There is limited evidence regarding long-term outcomes for treatment of chronic pain with opioids compared with nonopioid medications.
Who and When: 240 patients from Veterans Affairs clinics with moderate to severe chronic back pain or hip or knee osteoarthritis pain; patients entered the study from 2013 to 2015 and follow-up ended in 2016
What (Study Measures): Patients were treated with opioid or nonopioid medications (interventions); pain-related function (how much pain interfered with activities such as walking, work and sleep) over 12 months; pain intensity and medication-related symptoms (outcomes)
How (Study Design): This was a randomized clinical trial (RCT). RCTs allow for the strongest inferences to be made about the true effect of an intervention. However, not all RCT results can be replicated in real-world settings because patient characteristics or other variables may differ from those that were studied in the RCT.
Authors: Erin E. Krebs, M.D., M.P.H., Minneapolis Veterans Affairs Health Care System, Minneapolis, and coauthors
In other outcomes, pain intensity was less intense in the nonopioid group and adverse medication-related symptoms were more common in the opioid group.
Study Limitation: Because this study was conducted in Veterans Affairs clinics, patient characteristics differ from those of the general population.
Study Conclusions: The results don't support the initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain.
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(doi:10.1001/jama.2018.0899)
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Journal
JAMA