Opioids Not Best Option for Back Pain, Arthritis

After enrollment, half were randomly assigned to receive a year of opioid treatment. Depending on “careful trial and error,” Krebs said, this variously included morphine, hydrocodone/acetaminophen (Vicodin), oxycodone, and fentanyl patches. Daily dosages were restricted to 100 morphine-equivalent milligrams.

The non-opioid group received other pain relievers, including acetaminophen (Tylenol), and nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin) and naproxen (Aleve).

Over time, some patients in the non-opioid group were also offered prescription drugs, including amitriptyline or gabapentin, or topical analgesics such as lidocaine. In cases where nothing else worked, they were additionally prescribed nerve pain medications, such as duloxetine (Cymbalta) or pregabalin (Lyrica), or the narcotic tramadol (Ultram).

One year out, investigators determined that the two groups differed very little in terms of their ability to walk, work or sleep without pain.

The non-opioid group fared “significantly better” in terms of pain intensity compared with the opioid group, and experienced “fewer bothersome side effects,” Krebs said.

Dr. David Katz is director of the Yale University Prevention Research Center. He said that for treating long-term musculoskeletal pain, “use of opioids is both ineffective and ill-advised.”

“Anyone who has undergone surgery — and I have a number of times — certainly knows the value of opioid analgesia. When pain is acute and truly overwhelming, potent narcotics work, and essentially nothing else does,” he said.

“But the value of opioids fades quickly over time, and the liabilities increase,” Katz explained. “So an informed approach would tend to be very short-term use of opioids, when pain is most intense, with early and explicit plans to transition to alternatives.”

Katz agreed with Krebs that non-medicinal “holistic approaches to pain management, often involving team care, tend to be best” for controlling chronic pain.

“There are many ways to treat pain that don’t involve drugs at all,” Katz added.

The report was published in the March 6 issue of the Journal of the American Medical Association.

Article source: https://www.webmd.com/pain-management/news/20180306/opioids-not-best-option-for-back-pain-arthritis?src=RSS_PUBLIC

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