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Nonopioid Management Just as Impactful as Opioids for Back and Knee OA Pain

Randomized trial finds no significant difference in pain-related function after one year of compared treatments.

A PPM Brief

Researchers examining opioid versus nonopioid medications for chronic back and arthritis pain have discovered surprising results.1 Long-term outcomes of treatment (12 months) on pain-related function, pain intensity, and adverse effects demonstrated a lack of support for initiating opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain.

The randomized trial included 240 subjects (mean age =58.3 years; women = 32 ) recruited from Veterans Affairs primary care clinics between June 2013 and December 2015. Eligible participants had moderate to severe chronic back pain or hip or knee osteoarthritis pain despite analgesic use, and were followed up in December 2016.

Subjects using opioid treatment managed their pain with immediate-release morphine, oxycodone, or hydrocodone/acetaminophen. Subjects in the nonopioid group managed their pain with was acetaminophen (paracetamol) or a nonsteroidal anti-inflammatory drug. Medications were adjusted as needed based on individual patient response.1

Groups did not significantly differ on pain-related function over 12 months (overall P = 0.58). Pain intensity was significantly better in the nonopioid group over 12 months (overall P = 0.03), while adverse effects reported were significantly more common in the opioid group over the time period (overall P = 0.03).

The authors concluded that, “the use of opioid vs nonopioid medication therapy did not result in significantly better pain-related function over 12 months.”1



Last updated on: March 12, 2018
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