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Opioids Not Better Than Acetaminophen at Reducing Pain to Improve Function for Chronic Back, Knee and Hip Pain

Opioids Not Better Than Acetaminophen at Reducing Pain to Improve Function for Chronic Back, Knee and Hip Pain | Newtown News of Interest | Scoop.it

IMPORTANCE

Limited evidence is available regarding long-term outcomes of opioids compared with nonopioid medications for chronic pain.

 

OBJECTIVE

To compare opioid vs nonopioid medications over 12 months on pain-related function, pain intensity, and adverse effects.

 

DESIGN, SETTING, AND PARTICIPANTS

Pragmatic, 12-month, randomized trial with masked outcome assessment. Patients were recruited from Veterans Affairs primary care clinics from June 2013 through December 2015; follow-up was completed December 2016. Eligible patients had moderate to severe chronic back pain or hip or knee osteoarthritis pain despite analgesic use. Of 265 patients enrolled, 25 withdrew prior to randomization and 240were randomized.

 

INTERVENTIONS

Both interventions (opioid and nonopioid medication therapy) followed a treat-to-target strategy aiming for improved pain and function. Each intervention had its own prescribing strategy that included multiple medication options in 3 steps. In the opioid group, the first step was immediate-release morphine, oxycodone, or hydrocodone/acetaminophen. For the nonopioid group, the first step was acetaminophen (paracetamol) or a nonsteroidal anti-inflammatory drug. Medications were changed, added, or adjusted within the assigned treatment group according to individual patient response.

 

CONCLUSIONS

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

 

Further Reading:

Is There a Role for Medical Cannabis in Combating the Opioid Epidemic?

johnmacknewtown's insight:

We know that 40 percent of all opiate overdose deaths involve a prescription opiates, which are overprescribed for pain. Perhaps having legal access to cannabis as another option for pain relief may actually reduce consumption of opiates. http://sco.lt/5KKgZV Unfortunately, even though medical marijuana is available by prescription in PA, physicians cannot prescribe it for the kind of pain that this study focused on.

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Newtown News of Interest
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