Can Your Perception of Opioids Determine How Well They Work?

Preconceived notions can, in some cases, interrupt the effect of medication

A recent trial conducted by the United States Veterans Administration (VA)1,2 examined the pre-existing perceptions that individuals with chronic musculoskeletal pain, such as low back pain and arthritis, have about certain pain medications. The researchers sought to find out how these perceptions affect individuals’ experiences with these medications.

"Given evidence suggesting that treatment expectations can influence treatment response, we sought to gain a more complete understanding of the potential role of expectations and perceptions of opioids held by patients with chronic back, hip and knee pain," said author Marianne Matthias, a research scientist at the VA Center for Health Information and Communication at the Richard L. Roudebush VA Medical Center in Indianapolis, IN.

The 12-month trial compared the benefits and harms of opioid and non-opioid medications used to treat chronic back pain or arthritis in the hips or knees. The results showed that individuals who took opioid medications did not experience a significant improvement in pain that interfered with their ability to walk, work, or sleep compared to those who took non-opioid medications. Researchers also reported that adverse symptoms related to medication were more common in the patients who took opioids.

The patient’s relationship with his/her pharmacist was another important influence in determining an individual’s perception of a certain pain medication and its potential effect. "We found that personalized care by someone who cares—in this case by a pharmacist—often meant more to patients than the actual medications they were taking,” Dr. Matthias said. “Patients seem to value working with someone who cares about them and can help to meet their physical and emotional needs."

Finally, the VA researchers investigated patients’ experience with the trial itself. That’s right—despite the trial participants’ strongly held beliefs about opioid and non-opioid medications—as documented before the trial began, patients were still often surprised by their results.

For example, one trial participant said that her opinion shifted after she switched from an opioid to non-opioid treatment and found that the non-opioid actually relieved her pain. "I was expecting it not to be a 180-degree turn because I went from being just miserable every day to being just, for the most part, happy. I can basically just bounce right out of bed. I assumed…opioids were powerful. So they were necessary for extreme pain when that's not the case. So I do have a lot more respect…for non-opioids.”

Bottom line? It’s worth the effort to try (or retry) different therapies, including non-opioid options, to treat your pain and to keep an open mind, because you never know how effective they may be for you. In some cases, they may even be as effective as the medication you are already taking. Talk to your doctor about what therapies may be right for you.

Updated on: 10/10/18
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