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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  • Hi folks, I am late in this conversation. I believe responsible patients should not have needed medication taken away. Medication can make a difference on rather a person works, can participate in social and family activities, and also keeps many from being home bound. Conversely, I know that some doctors write prescriptions like giving candy out. Many chronic pain sufferers threaten the doctor, cry or become combative when they cannot get their prescription. Then we have the doctor shoppers that go from doctor to doctor to receive more than one prescription. These are the people to blame for the situation, as deviant people often act in ways that change societal rules and regulations. The article that was criticized here was published in JAMA, which is a peer reviewed journal of the best quality. That doesn’t mean that methods may not have been reported properly, but I doubt it. For a medical study the number studied is actually very good. I am a peer reviewer for another journal so am used to looking at these types of articles.

    Now, I am also a chronic pain sufferers who is probably ruining my kidneys and stomach for the so-called “alternatives”. We know that Tylenol can be fatal if not taken as prescribed in sensitive elderly patients. Advil, Morin and other similar drugs can make it difficult for edema sufferers to release fluid. The problem with these drugs, if seriously studied, may rival narcotic pain relievers. The difference is that narcotic pain relievers is addictive and because of the sense of well being it brings, is promoted by drug dealers as a way to make money. Again, the bad in society cause those who follow the rules to suffer. It is a cycle that needs to be stopped. If the medical community changes the way the medication is administered, it may be better for awhile. Like a gun, if someone wants it they will get it either legally or black market.

    There is no easy answer to this problem, as both sides have valid complaints. Legal marijuana may help to ease the pain in some, if that hasn’t been tried. In the meantime, we suffer or become fixtures in our doctor’s office.

    Comments?
    🧐

    • It’s all about money and control, yet the confused, doctor’s and the ever liars DEA giving doctor’s life in prison, yes some deserve it, yet it’s causing pandemonium, and if you read the CDC report they made it plain what is what, and they say as an excuse our lawyer’s can’t make head’s or tails, yet really it’s the pharmacist that are running the show, if they don’t like you, it doesn’t matter if Obama told them to fill your script, they are little god’s of law-abiding chemist’s chemist that buy and sell, you don’t see pain patients being allowed to become pharmacy technician’s, yet hopefully all pain management doctors, become hurt and need surgery, as well as all the DEA and Trump only because he is against anything concerning chemicals, booze and such, only because if the abuse of folks who just want to have fun, then are weak willed or been abused themselves, so they miss use of die, then all the parents cry, kill the monster drugs, because this pain can’t be helped, buy by hate and revenge, next false pride we want the money now. Something like that, but I do believe Trump wants to make America like back to the 70s, yes I know your thinking what?? Just texting my commitments, didn’t see that coming

  • They’re not including Opiates.
    Nsaid other OTC pain is NOT less risky. Those actually. Are the medications that significantly cause side effects such as organ damage, inhibiting ability to process Other medication and eliminate waste from the body. Kidneys specifically are at risk. The liver metabolizes other medications. later the clinical research for those with no prior organ damage. The risks to organs are lower to none. Opiates not their synthetic Opiod counterpart
    In fact OTC NSAID (kidney) and Acetominophen (liver) are often the ones with overuse, because in effort to get any significant pain relief, patients take more and more, either (falsely) believing they are safe, or in desperation with no other alternatives in the near or realistic future. Very few Americans have been Rx other NSAID side from ibuprofen. It is a very effective drug. However no one thing will ever be the only answer.

  • Back pain can be caused by many entitities. It looked like they used opioiids in diseases that other drugs worked effectively for. If the solely had looked at severe radicular pain the results would have been different. Thats what happens when people with an agenda develop badly designed studies.

    • I was dissed by the medical community as a whole. I despise doctors because of this, and there is nothing that would be deemed as “too harsh” a punishment they should receive. I sincerely hope & pray they suffer as much as possible, and in every way possible. I could not be more serious about this.

  • This is BULL and every test so far that they have done is BULL. I wont accept fake results from busy bodies that continue to downgrade the pain I have so addicts can be coddled. Everyone dies. There is no escape. The choice is yours to abuse substances. If you take your medications with pain just in the background and you are NOT high your taking the correct amount. The smallest amount is given and pain patients in a REAL pain management program are not high. If they are, they are being watched in a hospital environment. Fentanyl and Oxy are not good pain relievers but they are short term acting because of worry of addiction. They can be better pain relievers given appropriately to MATCH the person’s pain receptors. EACH person is different, and EACH medication binds differently to the RECEPTORS differently, and SYNTHETIC Pain Medications do not bind to PAIN RECEPTORS completely and evenly (another issue why they need frequenly need more meds to cover the same pain ESPECIALLY 8 hour OXY) only Natural pain medications do. Anyone doing a study should make that FACT known. They should also say that Acetaminophen, IBUPROPHEN AND ANY OTHER NSAID can and will cause LIVER AND KIDNEY DAMAGE used long term 24/7. Opiates do not.

    • I don’t know as muchas you seem to…but, taking your knowledge as accurate, it sounds very much like my opinion formed from my own personal experience. As a quick example of affects of reducing my perscription, I broke one molar in half the first week of the reduction and a second one a week and a half later. Perfectly good teeth, I might add. Can’t NOT react to pain in your sleep.

  • An employee of my dr got fired for going through people’s charts and calling other patients and telling them personal information. She lied, violated the hippa law every day, would call the dr at home, etc. She got fired and called the DEA on him and told the DEA which charts to look at. I was going to him for 16 years. We all abided by the laws. We all had yearly evaluations from orthopedists, went to pain management for other solutions, which the dea asked his pain patients to do. I have a metal rod in my arm that hits my shoulder, bulging herniated discs with arthritis in my neck and back. The medication I was on let me work, and go back to school in the medical field . After 2 years the dea sent a letter to the dr that he can’t. Prescribe ANY pain medication! No one died from an overdose, so with no notice we ,the patients on pain medication were given no notice from the DEA and are left to freak out, pay for another dr if we can find one and maybe not be able to work to support our family’s. HOW IS THIS HELPING PEOPLE WITH REAL PAIN!!!!!!! And never mind getting so sick. This is inhumane! !!

  • Your test are bogus I’ve taken opioids for over five years, got off them twice and over the counter drugs had no effect on my pain in my back, knees and headaches.

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