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HICAGO — 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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  • This study included only one very specific type of pain that is already well-known to respond best to non-opioid treatments. There are many, many kinds of pain in the world.

    Consider, for instance, a rare autoimmune disease in which the body attacks its own tissue, creating open wounds which do not heal. For that kind of pain, opioid pain medication can give these patients a near-normal life for 20-50 years or more.

    How do I know? I am one of them.

  • Erin Krebs gets the results she wants to get, so her buddies (Andrew Kolodny, Jane Balantyne, etc.) can keep pushing the nopioids agenda. This wasn’t that great of a ‘study’, and not nearly as conclusive at your headline makes it sound. Thanks for your patient support of the…patient, who now gets to suffer because of idiocy like this.

  • This is “fake news”. Opiates work for my pain (cancer and chronic pain)I have tried everything else and nothing works. You are killing people with this s false article. Shame on you!

  • You guys lie like rugs and if I were to take ANY MORE non opioid pain meds for my severe chronic pain my GI Dr said it would cause more painful ulcers that om opiate drugs like ibuprofen. My kidneys are ad so my urologist doesn’t want me to takt tylenol so opiates are the only thing I can take guess I’ll take the other ones and when I die my husband will sue! You stupid AP press walk in my shoes a day you will be screaming for opioids and at the stupid DEA and CDC. I can no longer pursue a life of LIBERTY & happiness because they are pulling me off what makes life worth living. This has got to stop it’s GENOCIDE. This is what is killing “drug addicts” I hae taken opiates for 10 yrs without issue. early refills and passed all my random tests. My pain management physician has even told me “I hawe no problem with you.” Now cannabis is legal but you insist on us buying costly cards yearly.You all need to stop lying. OTC drugs kill and this has even been proven. The DEA is now trying to pull a fast one by lowering us further!! Call ME I know the facts! Please come film me and how I have to live now!

  • You guys lie like rugs and if I were to take ANY MORE non opioid pain meds for my severe chronic pain my GI Dr said it would cause more painful ulcers that mom opiate drugs like ibuprofen. My kidneys are ad so my urologist doesn’t want me to takt tylenol so opiates are the only thing I can take guess I’ll take the other ones and when I die my husband will sue! You stupid AP press walk in my shoes a day you will be screaming for opioids and at the stupid DEA and CDC. I can no longer pursue a life of LIBERTY & happiness because they are pulling me off what makes life worth living. This has got to stop it’s GENOCIDE. This is what is killing “drug addicts” I hae taken opiates for 10 yrs without issue. early refills and passed all my random tests. My pain management physician has even told me “I hawe no problem with you.” Now cannabis is legal but you insist on us buying costly cards yearly.You all need to stop lying. OTC drugs kill and this has even been proven. The DEA is now trying to pull a fast one by lowering us further!! Call ME I know the facts! Please come film me and how I have to live now!

  • I could give a lengthy story of my own situation, but youve all pretty much said what id say. I agree we have to unite. What do we have to loose? Its going to kill my elderly mother. I usually dont get involved with much. I dont often feel good enough. Even though this is the case i would be interested to support this. All i can say is it my worst nightmare come true. I relate to everything everyone has shared. Im happy to have found your comments to this nightmare we face.

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