Millions of Americans are living with pain conditions and have been prescribed powerful opioids to cope with the pain, fueling the worst drug crisis in US history. Evidence revealing the serious risks involved with opioid therapy for pain management continues to grow and receive widespread attention. According to a recent study, it appears that opioids may not be any more effective than nonopioid medications, such as nonsteroidal anti-inflammatory drugs (NSAIDS) for treating chronic back pain, or hip or knee osteoarthritis-related pain.
These findings were released in the March 2018 issue of JAMA (Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients with Chronic Back Pain or Hip or Knee Osteoarthritis Pain: The SPACE Randomized Clinical Trial). The 12-month randomized trial included 240 patients from Veteran’s Affairs' primary care clinics with moderate to severe chronic back pain or hip or knee osteoarthritis pain. They were divided into 2 groups: 1 group was treated with opioid therapy, and a second group received nonopioid drugs, such as acetaminophen and NSAIDS.
A range of tests were used throughout the study, with a primary focus on how pain interfered with function and pain intensity. Both were measured using the Brief Pain Inventory (BPI) and the BPI severity scale, which measures on 10-point scales (10 indicated highest pain interference or intensity). At the 12-month mark, researchers found no significant differences in how pain affected the ability to function between the 2 groups. The opioid group scored an average of 3.4 in BPI function and the nonopioid group scored an average of 3.3. And the nonopioid group reported a greater reduction in pain intensity, with an average of 3.5 vs 4.0 from the opioid group.
Authors concluded, "Overall, opioids did not demonstrate any advantage over nonopioid medications that could potentially outweigh their great risk of harms."
The American Physical Therapy Association raises awareness about physical therapy as a safe and effective alternative to drugs for the treatment of pain. It aligns directly with the Centers for Disease Control and Prevention’s opioid prescription guidelines (March 2016), citing "high-quality evidence" supporting exercise as a part of a physical therapy treatment plan for low back pain, hip or knee osteoarthritis, and fibromyalgia.
Access additional Did You Know? pages.