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.


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 seems to be extremely misleading as they only looked at select conditions and mild chronic pain with a select few pioids. To make a blanket statement on opioids and chronic pain as being representative for all types of chronic pain based on such select criteria is at the best misleading and is more representative of a political agenda!!

  • It is truely amazing how a class of medications (opioids) that has been used very effectively for hundreds of years, has suddenly become non-effective at treating pain. As a former practicioner and a current chronic pain patient, there is zero doubt in my mind that opioids are very effective at decreasing pain levels in both acute and chronic pain. What I find most disturbing is that the medical profession seems to be willing to bow down to government control at the expense of doing harm to their patients whom depend on these medications to live a functional/tolerable life. Until a new pain medication is developed that is equally or more effective at decreasing pain, that doesn’t target opioid recepticles, practitioners have a moral, if not legal, obligation to provide their patients the best treatment available. I hate to say it, but I think pain patients need to start suing doctors for substandard pain management.

  • Where do these people come up with this stupid s#$t? I have been disabled since 20012 after 44 years of brutal carpet installing. I have had numerous surgeries, facet and epidural injections. nerve burnings, and a spinal cord stimulater, all in hopes of returning to my job that I love. I have been prescribed NSAIDS, along with a host of other meds. but if this story is true, why is the only thing that even helps me take care of my basic needs is a miniscule {45mg. per day} of oxycodone. I am very family with the old placebo ploy, and that isn’t the case with me. When the government talks about other countries treating their citizens badly, I want to throw up. They have declared war on us chronic pain patient who can’t defend ourselves. Talk about hypicrosy!! Keep printing lies like this, and maybe if you can find someone like Ward and June Cleaver, someone will believe it. it’s so easy to see why it’s even printed anyway. Maybe it will pacify a few, but not people with REAL pain. Keep up the lies.

  • Pain News Network published a couple of excellent articles regarding this “study.” Some things not mentioned in this “study,” which was conducted by a biased anti-opioid doctor who was also an original member of the Core “Expert” Group, which helped draft the “voluntary” CDC Guidelines on Treating Chronic Pain (mainly outlined by some who have a conflict of interests in the name of money. She’s also appeared within a lecture series on opioid prescribing that was funded by the Steve Rummler Hope Foundation, which is a anti-opioid lobbying group affiliated with PROP and “Dr.” Andrew Kolodny – both of whom stand to profit from all the government grants (aka money).

    What is also not mentioned is the fact that some cases of pain are better relieved by NSAIDS while other cases of pain are better relieved by opioid-based medication, mmj, kratom, gabapentenoids etc. Each human is different. Each pain patient is different, especially when it comes to how their bodies absorb and/or metabolize opioid-based medications, as some people lack the necessary liver enzymes needed to properly metabolize this class of medications. What works for one does not always work for another. This is why practicing medicine is considered both a science and an art. Anti-inflammatories, opioid-based medications, kratom, mmj, gabapentinoids, etc. are all very valuable options in the treatment of pain.

  • Your headline is obfuscating the true nature of the findings. This study did not look at all types of chronic pain, rather only “stubborn back aches or hip or knee arthritis” and therefore it is unconscionable to lead with a headline that suggests OTC pain medication is comparable in all cases of chronic pain. Given the conversations about opioids that are causing panic in clinicians and patients alike, I think you should correct the headline.

  • Very interesting article! My mom is taking ‘Sovenor’ pain patches plus Tramacet and Ibuprofen because she has strong chronic back pain…Sovenor is very expensive and has a lot of side effects…..

    • Annette, I do hope your mom has a very healthy liver and stomach because her current course of treatment will take its toll soon enough. I wish her relief from her chronic pain as it is no way to try to live. If we’re no longer able to use low dose long acting morphine then please legalize marijuana. It’s just a plant!

  • As a patient who has suffered chronic pain for 26 years, I can tell you that using otc medication does absolutely nothing for my pain. I have been through physical therapy Numerous times, chiropractors, acupuncture, massage. I have also had steroid procedures, epidurals, and been on practically every medication there is. Opiates are the medicine that works when nothing else does for my chronic pain. I also take prescription ibuprofen, lidoderm patches, arnica spray, and biofreeze gel, and a muscle relaxer as needed . All of that in combination with an opioid brings my pain level down to a level that I can live with. I am currently unabIe to exercise due to my pain levels. I call Bulksh!t on this so called pain study.

  • Ya, I have a feeling this “Study” was set up and designed for opiates to FAIL. Given todays society and how far the pendulum has swung into patient negligence and Medical malpractice against pain patients of course a study has been “Set up” to show that over counter meds work better than opiates. BS. I have a very painful disease, I have tried everything including over the counter meds & prescription strength over counter meds and opiates along with injections, physical therapy, massage therapy, tens units etc…Opiate medication was the ONLY thing that has allowed me to live a somewhat normal functional life. There is an all out “Prohibition” on opiates going on right now…and these studies are OFTEN SET UP FOR A ONE WAY OUTCOME. Its obvious to me that these results were meant to find over counter pain relievers to work better. I dont believe a word of it and I know as I have lived this first hand. You may be able to take over counter pain relievers for Acute short term pain fine…however, long term your liver & kidneys would be blown out causing early demise and your quality of life would be zero. No Thank you.

    • There is no way that this was ‘set-up’ because that would mean all the veterans who agreed to do this study were told how to answer and they all kept quite and did it. I don’t believe in any conspiracy that involves huge numbers of people being ‘in’ on it. I understand your frustration, different drugs affect people differently though. Although you have only found relief in opioids the study is showing that, on average, people do better with non-narcotic painkillers. I’m sorry but a bunch of people like getting high on these drugs and then they overdose. The few irresponsible people are ruining it for the people who actually need it, I get it. I don’t think this is an all-out assault on opioids though, I interpreted the conclusion as suggesting that non-narcotic should be first-line treatment (as in the first things they try). I agree with this sentiment, they should not be prescribing Vicodin, oxy, and fentanyl as soon as someone is in pain. There needs to be a concerted effort by the medical community to not prescribe opioids until the alternatives have been exhausted. I don’t believe they’re trying to suggest taking scripts away from people, but if something doesn’t change then the government might step in and pass legislation, which would be very bad for pain sufferers and the medical community.

  • This is insanity for people who are actually in severe pain. Because Hollywood brats and drug addicts want to get high, people who would actually commit suicide if they didn’t get to take “opoids” to get some relief from the unrelenting pain they go through EVERY day, they are the ones who suffer. I can only hope and pray that these idiots who are passing these insane laws, have something happen to them where THEY are in constant and unrelenting pain!!! Then come and talk to me…

    • Hurley, I agree!! As a pain patient for over 10 years I am grateful and thankful to the medical professionals that have provided my treatment. I have been able to survive 2 very extensive back fusions, raise 2 children, and have a career….. a relatively normal life. The addicts are going to be addicts regardless.

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