Hundreds of thousands have died of overdoses since the epidemic started
Opioids are powerful pain-relieving medications that have been around for a while, but it wasn’t until the late ‘80s and early ‘90s that “the opioid epidemic” really started to pick up. Around this time, it was believed that opioids could be used safely and effectively to treat chronic (long-lasting) pain. This misguided belief led to opioids being overprescribed for pain on a massive scale, and since the epidemic started, at least 300,000 people have died of opioid overdoses. More than 30,000 Americans are expected to die of opioid overdoses in 2017 alone, and the epidemic appears to only be getting worse in certain areas of the country. To further investigate the misguided belief that led to this epidemic in the first place, a powerful study called a randomized-controlled trial (RCT) was conducted that compared opioids to non-opioid medications for treating patients in pain.
Large group of patients followed over one year
Veterans with moderate or severe chronic low back pain (LBP) or hip or knee osteoarthritis were invited to participate in the study and screened to determine if they were eligible. This led to 240 individuals being accepted and randomly assigned to either the opioid or non-opioid treatment group. Patients in the opioid group received a combination of different drugs at various times over one year that included morphine, oxycodone, hydrocodone and fentanyl. Patients in the non-opioid group received a completely different combination of drugs that included acetaminophen, non-steroidal anti-inflammatory drugs and lidocaine, amongst others. All patients were monitored regularly over one year, and at the end of the study they were evaluated for pain-related function and pain intensity.
Opioids do not lead to any benefits over non-opioids for pain
Results showed that patients treated with non-opioids actually experienced better outcomes than those treated with opioids. In particular, there was no difference in pain-related function between the two groups, but the non-opioid group reported less pain intensity than the opioid group. This was considered a small but significant difference. In addition, patients in the opioid group experienced significantly more adverse symptoms related to their medication than the non-opioid group. This RCT is the first study that compares the two types of medications in the long-term, and it provides strong evidence that opioids should not be the first line of treatment for chronic musculoskeletal pain. More research is now needed to further support these findings, but this study is considered a major breakthrough that has filled a major gap in the evidence on opioids for chronic pain. The subject of prescribing opioids will continue to be controversial, but this trial will play a significant role in the discussion moving forward.
-Summarized by Greg Gargiulo
-Summarized from an article published in the July ’17 issue of The Back Letter