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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  • Have lived with chronic pain since a head on collision motorcycle accident around a blind curve in 1977. Have been thru. 45 operations on left leg along with 3 total knee replacements. Accident was not my fault. Had fractures from head to toe. A miracle to be alive. But the pain I have lived with has cost me my job, marriage and a great # of sports I was enjoying at the times. 6 years ago I went to pain management was put on methadone 5 mg 3xday. Was dismissed from Dr. when they quit taking medicare patients. Out of help for approx. 6 months. Went to different clinic tried hydrocodone 5mg no relief went up to 10mg at first it was helping. Then on my next refill pharmacy changed manufacturing co. , within 30 min. My body acted like i was going thru withdraw stomach pain, diarrhea nausea, very lightheaded almost passing out if i didn’t sit down quickly. Soon as i set down i started throwing up. Had to stop taking them. Called the pharmacy that’s how i found out they had switched manufacturers. Changed over to Percocet 7.5/325. 3xday same thing happened first ones worked great. Next time it was same ole crap…no pain relief when they used different co. I’m totally convinced chronic pain patients are being tortured by our Gov. to do away with pain meds. So tired of it. Want to get involved with a lawsuit and advocacy group to fight against these pharmacy that are charging our insurance co. mega bucks for these Horrible Generic Medications. They don’t work!!🤕

  • Thanks to the idiots who steal, sale and abuse opioids just to get high and eventually kill them selves and to the lousy government who makes the innocent pay the price.

  • This results of this “study” were grossly skewed towards the results desired by the admittedly biased Dr who conducted it. Having practiced medicine for many years, I can atest that there is zero doubt in the medical community, that opioids are way more effective at treating pain than any other pain meds on the market, excluding local and general anesthetics. Forcing legitimate pain patients to take other, less effective pain medications while more effective, safer opioids are available is unexcusable and outright cruel to those suffering from severe chronic pain. According to available medical literature, very few opioid overdose deaths have ever occured by patients taking the properly prescribed dosage, unless having been taken with other CNS depressants, or having an abnormal hypersensitivity to opioids. More legitimate studies have also shown that the percentage of opioid addiction in chronic pain patients is far less than opiate addiction in the general public, having never been prescribed opiates.

  • I wish these pharmaceutical companies would fund some real research–nobody else is going to do it. And I’m tired of reading publications that summarize findings of ‘opiates are bad’ rather than simply stating the fact that opioids have never been studied in this way, or for this thing.

  • HUGE ISSUE MISSING HERE!!!!!!ASK KREBS WHAT DOSAGE OF OPIATE MEDICINE WAS ALLOWED??!!!!!!IN SOME CASES ,<50 ME WERE ALLOW' FOR A 250 POUND WOMEN,,,POINT BEING,,THEY USED ANYWHERE FROM <50 ME TO <90 ME,,,,WHICH AS ALL CPP'S KNOW,,,IS A NON-EFFECTIVE DOSE OF OPIATE MEDICINE,,BUT U NOTICE THEY FAIL TO MENTION THE ACTUAL AMOUNT OF OPIATE MEDICINE,''ALLOWED,'',,ON PURPOSE BTW,,,THEN KREBS DOCUMENT NO DIFFRENCE IN FUNCTION LEVEL,FOR THOSE PATIENTS ,''ALLOWD,'' THEE NON-EFFECTIVE DOSE OF OPIATES,,,WELLL DAHHHHHHHHHHHH,,,,,I GUESS U NEED A COLLEGE EDUCATION W/THESE ANTI-OPIATE TORTURES,,,TO LEARN HOW TO TELL EFFECTIVE LIES,MANIPULATE THE MASS'S,,,TO BELIEVE YOUR LIES,AGENDA,,,FROM NOW ON FOLKS,,,ALWAYS ASK THE DOSAGES USED IN ALL STUDIES,,,CAUSE THEY HAVE PURPOSEDLY USE SUCH LOW DOSAGES SO THEY CAN CLAIM OPIATES DONT WORK….MAYBE ,'' THE WHY ,''THEY TRIED/DID DESTROY DR.FORREST TENNANT,,,A MAN W/MORE AWARDS FOR GOOD WILL ONTO HUMANITY THEN MOTHER THERESA,,,maryw

  • Nasty side effects of opiates? I nearly died from taking NSAIDs. Never had any such problem w opiates. Tylenol or ibuprofen taken daily for chronic pain will kill you a whole lot faster than opiates (taken as directed) and why is it that while a person can’t get a script for pain medication should their life literally depend on it..these days, that overdoses aren’t going down?! I’ll tell you why bc the deaths the media loves to blame on prescription drugs are almost always illicit drugs or medications illegally obtained. Chronic pain patients are committing suicide bc all they have access to are OTC drugs. This study is more anti-opiate propaganda.

  • “The report did not break down overdoses by type of opioid.”

    Did the report break down overdoses by prescribed drug vs. illegal. I had paramedic driver tell me that 99.9% of the opioid overdose calls are people who obtained the drug illegally. Sadly real statistics are hidden.

    This whole crisis was handled irresponsibly. What else is new. Cancer patients are dealing with untreated pain and constant stress; because of bunch of convoluted rules. The pharmacy’s are having problem keeping the drug stocked. There coming from unregulated countries that are manufacturing opioids for Big Pharma. Some of the opioids are down right ineffective and make you sick. Were all suffering except the powers that be who made up the rules.

  • The doctors did same thing to me. Causing spasms so severe that they buldged multiple disks in my spine.
    And then denied me referring to. Medical treatment and kicked me to the curb. I lost 15 pounds from throwing up from the constant pains and collapsed memorial weekend.
    I somehow survived a allergic reaction, then bleeding ulcers from a medication. My kidneys are damaged and denied treatment from the medical community here to cover up their malpractices for 20years and the war on opioids.
    I cannot function anymore and will probably die from what they have done to me before I get proper diagnosis and care.
    There is a good chance that I have cancer and because they all have their heads up their asses with this war on opioids they refuse to look at any other health issues because of me being on a opioid medication.
    FTW……..

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