Opioids Not Better Than Non-Opioids For Chronic Pain

Healthcare workers have a tendency of prescribing opioids to patients suffering from moderate to severe pain. Over the past two decades, it has become obvious that the opioids are dangerous drugs with many side effects. Dozens of cases of opioid overdoses are reported every day across the country.

The opioid epidemic has resulted in a significant criticism and evaluation of how healthcare workers manager pain and if there are other safer options. The general feeling in the medical community is that opioids are the most effective pain relieving medications but is this really true?

A recent study compared nonopioid drugs to opioids drugs in patients with knee or hip osteoarthritis or persistent low back pain. The results are astounding.

Way before opioids became a public health crisis, Dr. Erin Krebs, a medical fellow from North Carolina in had observed that many patients who were prescribed opioids for low back pain and arthritis were not better-off.  Instead many were becoming addicted to these drugs.

She decided to do a literature search on the long-term use of opioids and found that most early clinical trials were short-term (around 8-12 weeks) and all studies only compared the opioids to a sugar pill.

She then conducted a large-scale study where the use of opioids and non-opioids could be compared in patients with chronic pain. What she and her colleagues discovered was that nonopioids were far more effective for chronic pain and much safer than opioids. The study had just been published in JAMA.

In the study, the researchers compared opiates like morphine, hydrocodone, and oxycodone to nonopioids like acetaminophen, naproxen or meloxicam. The pain intensity and function were measured over 12 months.

The striking results were that patients treated with opioids did no better than those on non-opioids. The study also revealed that opioids were not only as effective as nonopioids, but they also had serious side effects, including the risk of addiction, development of tolerance and even death.

Most experts believe that it is the big pharmaceutical companies who consistently promote opioids for chronic pain management, without having any solid clinical evidence that these drugs are actually effective.

With the current opioid epidemic in full swing, perhaps this study will finally change physician attitudes in the management of pain. However, it is important to note that opioids are still effective drugs for pain caused by cancers and patients should not be denied these drugs when needed.

The management of pain is complex, and even today we do not know which population will benefit from opioids or nonopioids. In the meantime, physicians should start to change their prescribing habits in favor of nonopioids and use opioids at low doses only when indicated.

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