CHICAGO — A yearlong study offers rigorous new evidence against using prescription opioids for chronic pain.

In patients with stubborn back aches or hip or knee arthritis, opioids worked no better than over-the-counter drugs or other nonopioids at reducing problems with walking or sleeping. And they provided slightly less pain relief.

Opioids tested included generic Vicodin, oxycodone or fentanyl patches although few patients needed the most potent opioids. Nonopioids included generic Tylenol, ibuprofen and prescription pills for nerve or muscle pain. The study randomly assigned patients to take opioids or other painkillers. That’s the gold standard design for research.

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If they don’t work better than less risky drugs, there’s no reason to use opioids given “their really nasty side effects — death and addiction,” said lead author Dr. Erin Krebs, a physician and researcher with the Minneapolis Veterans Affairs Health Care System.

The results likely will surprise many people “because opioids have this reputation as being really powerful painkillers, and that is not what we found,” Krebs said.

The results echo less rigorous studies and bolster guidelines against routine use of opioids for chronic pain.

The study was published Tuesday in the Journal of the American Medical Association.

About 42,000 drug overdose deaths in the U.S. in 2016 involved opioids, including prescription painkillers, heroin and fentanyl. Many people get hooked while taking opioids prescribed for injuries or other short-term pain and move on to cheaper, more accessible illicit drugs like heroin.

A report released Tuesday by the Centers for Disease Control and Prevention found emergency rooms saw a big jump in overdoses from opioids last year. Opioid overdoses increased 30 percent late last summer, compared to the same three-month period in 2016. The biggest jumps were in the Midwest and in cities, but increases occurred nationwide. The report did not break down overdoses by type of opioid.

U.S. government guidelines in 2016 said opioids are not the preferred treatment for chronic pain, and they recommend non-drug treatment or nonopioid painkillers instead. Opioids should only be used if other methods don’t work for chronic pain, the guidelines recommend. Prescribing rates have declined slightly in recent years although they are still much higher than two decades ago.

Krebs said the strongest evidence from other studies shows that physical therapy, exercise, or rehabilitation therapy works best for chronic pain. And she said noted that there are a variety of nonopioid drugs to try if one type doesn’t work.

The study involved 234 patients from Minneapolis-area VA clinics who were assigned to use generic versions of opioids or nonopioids for a year. Follow-up ended in 2016.

“This is a very important study,” said Dr. David Reuben, geriatrics chief at UCLA’s medical school. “It will likely change the approach to managing long-term back, hip and knee pain.”

He noted one limitation — most study participants were men, but Krebs said the results in women studied were similar.

The study’s opioid patients started on relatively low daily doses of morphine, oxycodone or generic Vicodin. They switched to higher doses if needed or to long-acting opioids or fentanyl patches. The nonopioid group started on acetaminophen, ibuprofen or similar anti-inflammatory drugs. They also could switch to higher doses or prescription nonopioid pain pills. Few in either group used the strongest medicines.

Patients reported changes in function or pain on questionnaires. Function scores improved in each group by about two points on an 11-point scale, where higher scores meant worse function. Both groups started out with average pain and function scores of about 5.5 points.

Pain intensity dropped about two points in the nonopioid group and slightly less in the opioid patients.

Other research has shown that over-the-counter medicines can also work as well as opioids at treating short-term pain, including from broken bones, kidney stones or dental work.

— Lindsey Tanner, Mike Stobbe

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  • I have lived with increasing levels of pain from Degenerative Disc Disease for the past 25 years. When I first started having pain, I used OTC medications (primarily Ibuprofen) successfully but as the disease progressed (as reflected by MRI scans) it was no longer effective. About 18 years ago I was first prescribed Vicodin, an opioid pain medication. This was eventually replaced by Percocet. Finally a knowledgeable doctor told me that the daily intake of Acetaminophen that is in both those medications was a greater health risk than the opioid. He switched me to Oxycodone which is the same opioid in Percocet. For the last 12 years I have rotated my medication (switched from one opioid to the equivalent dosage of another) to help counter any tolerance build-up without ever increasing my MED. The myth that opioid use inevitably leads to the need for increasingly higher doses is just as false as the claim that OTC meds are as effective as opioids. It may be that at some point my pain will worsen to the point that I will need to increase my MED but that is the reality of a degenerative condition, the pain worsens. If OTC medication was as effective as opioids, I would still be taking it. It was the fact that it no longer controlled my pain that caused me to seek an alternative. The alleged results of the study that suggests otherwise is ridiculous. As someone who has multiple degrees that required an understanding of research and the validity of results, my first question would be: Who funded the study? Followed closely by: Have those results been replicated by other independent studies? Finally: What measures were taken to control each possible variable? Without knowing the answers to these questions, the study report is meaningless. Data from a given study can be massaged in any number of ways. Likewise, any number of factors, intended or unintended can skew outcomes. Lastly, anyone can claim anything. If there is one thing that is not subject to scientific bias, it’s our own experience that informs our common sense. If OTC pain medication was as effective as opioids, why would Big Pharma have invested so much money in the R&D to create prescription pain killers?

  • I have been seeing a pain Doctor for almost 5 years now i suffer from osteoartrtis of knee ,Chronic sciatica,two total hip replacments,Artrtis of spine,Ankylosis of sacroilac joint,Scoliosis of thoracic spine,Osteoartrtis of coccyx and the list goes on I Have make the choose to go off my meds because my brain was being affeced by all the medication .I was slowly losing the ability to spell as well became depressed.When you do your research with MAYO CLINIC you will find they have come a long way to help with pain other then Opiates.MOST ailments that pain doctors give you opiates for don’t treat the real problem you my be having JUST takes away pain .There are mediction for some of the things you are suffering from and can be cured Most like myself did not want to see it that way for may years I was addicted to the meds .Now getting treatment for most underlined issues my brain is working better And the natural opiates you were born with are starting to work again As well as the ability to laugh.You my not notice these things are gone.What do you have to lose why not try .Why not try and not take your meds for one day.If you can drive your self to the pain Doctor on your own and want hours to see him YOU should be well enough to try to go a day with out .IF you feel sick more then pain try some thing else .NO BIGGER JOY IN LAUGHING AGAIN !!!SENT WITH LOVE

  • Having read the article I am concerned about the overgeneralizations being made from a study of what I would consider mild to moderate low back and osteoarthritic pain in the legs to severe pain and pain from other causes. Pain is not one disease and severe pain is a very different animal than moderate pain.

    I am also concerned that this is another example of how group effects are forced upon individual patients. Medicine has become a Procrustean bed upon which patients are forced to conform to group norms with no respect for their individual condition.

    Most patients who have pain, even pain they describe as severe will do fine with non-opioid treatment. That does not mean that all patients will be able to do so. Why, I don’t know, but the current tendency is to blame such patients and tell them that most other people can do well without opioids so they just need to buck up.

    We don’t do that in other areas of medicine. Most people with oropharyngitis will do fine without antibiotics. We don’t tell the ones who are not getting better without antibiotics that they should just buck up and get better.

    So overall I would consider this study rather useless and it doesn’t tell me anything I don’t already see in my practice. Mild to moderate musculoskeletal pain does not respond well to opioids for the vast majority of patients who have it. Given the emotional and political climate surrounding this issue it seems like its results are going to become overblown and misrepresented.

  • It said otc pain meds can work as well as opioids for treating kidney stones. Lmfao!!!!! I passed 14 stones last year. I would love to see someone do that on Tylenol or aleve. Percocet barely took the edge off. I would end up rolling around in pain not being able to take anything because I’d already took the max dose. This is a fucking joke

    • I TOTALLY AGREE Jeff! My pain management MD that I have had for 16 years with crystal clear urines looks so sad everytime I go see him. He sees me in tears (after all we have known eachother 16 yrs!) he looks down and shakes his head sadly.)MyPain Management Dr is the best & I love and pray for him he’s very handsome too lol) because I don’t want to loose him he’s so nice & caring……you ever known a Dr like this? That cares and fears both loosing his job! I know he doesn’t like to be a regular Dr but I guess the gopvernment and the CDC and the DEA seem to think they know better. This is against the law my friends….you can’t play Doctor without the license! There’s this show called BTW people, there is a class action suit against the CDC AND it should be against the DEA as well!
      When are they ever going to get that the drug war was lost long ago?! (Old farts never had “pain “management but gave out pain meds!)You know what they did to me? I had a great ma and pa pharmacy & would be in & out of there in 5 minutes (30 mins CVS) with my pain meds. I never abused my meds and even the pharmacy friend Justin said he knew I was NOT an addict but see we live in a cluster of small towns….everyone and his dog was going to MY pharmacy!Why did they not tell these people, we only accept prescriptions from surrounding citiy/towns touching our location! I think the owner got greedy. Well Justin told me the DEA stormed in and shut down their narcotic license…those are $$$$$$$$$$$$$ I hope the owner changes the rules so they don’t get busted! I am also angry these people did it to me also. So now I have to go with an mail order business and that scares me to death if someone should steal it and some @#$%^&drivers for UPs (they’re the worst) would leave it at the apartment office! ALL of them. WTH are they being paid for?! ok end rant I only live an hr from Sacramento CA so you would think this mail place could get it to you on your due date! Fed EX is pretty good but NOT on the weekends.I fear I will go into detox etc. A MA heard me asking about where to get my C2s one of them is Norco and Walgreens didn’t even get a shipment so far this month!The 19th now?! Oh and the hospitals don’t have enough injectable and pill pain meds! People can’t get their surgery and die! 🙁
      Blood is on the hands of the CDC and DEA. I do NOT care we give out the most opiates in our country we have hard jobs I was a nurse and taking my patient back to her room to give her GT feed & suddenly she falls! And the CNAs and I had NEVER seen her fall. (What are the odds? I am late 50s and have had probably 10 operations [plus a huge back surgery last yr)I am a mess!The only job I could get wa Only thing was we were dumb and stupid and didn’t get a car, house etc. We are being accused of diverting our meds when they have NO proof. This article by Lindsay Tanner is a LIE to the American people. This is genocide we are worthless drain on society because we cannot work! That’s what the government and the CDC etc thinks. Hope everyone signed the suit! Write me anytime I am proactive in chronic pain since they started playing Doctor, Is this political? I think there is a police state coming if they do NOT give chronic oh and cancer patients pain meds. This is simply BARBARIC & we need to all stand up and say No way we didn’t divert or do hard drugs. I’d rather die than “chase the dragon!” (You know…everyone that is dying from heroin because it has Fentanyl in it which kills them it’s 10x stronger! A lot of CP patients are taking their lives. I’ve tried it twice but God isn’t ready for me yet.(Shoot!! I hurt, lol)

  • Smacks of bias, devoid of meaningful information. Thanks for trying to make our already terrible pain experiences even worse by providing more fuel for Our Buffoon’ rants.

    • This is the most misleading and outlandish hit piece I’ve ever read in comparison to any article on “opiods”. To assume that one could have total hip replacement or a total knee replacement surgery and not require at the very minimum a 7.5/500 hydrocodone. Has neither ever had any major surgery nor have they experienced serious chronic pain due to cervical, thoracic, lumbar herniations, spondylosis, or neuropathy. I can’t remember having ever read an article more intentionally bent on outright lies and misinformation.
      Lindsey Tanner and Mike Stobbe should go in shame and continue to live out the rest of their careers hiding their heads in the sand

  • As a pain patient that has chosen to go off opioids 4 times and tried more than 10 alternatives I notice that the information on the study is very limited . There are no patient information, such as pain level before the test, they could have been pain patients that were recovery from procedures, there is just no information. It looks like this was created for a specific result, therefore worthless.

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