Opioids no better than Tylenol for treating chronic pain

Some people swear by opioids — it’s the only thing that helps them get through the day, they’ll argue. But a new study found that opioids aren’t really justifiable for chronic pain management. Generic medications (like Tylenol or ibuprofen) are just as effective and have fewer side effects.

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A new comprehensive study offers rigorous evidence against the usage of opioids. Dr. Erin Krebs, a physician and researcher with the Minneapolis Veterans Affairs Health Care System, recruited 240 patients suffering from chronic back pain or hip or knee osteoarthritis. He then split them into two groups, assigning half of them to receive opioids, and the other half to non-opioid drugs. He then followed them for up to a year.

The opioid group was prescribed morphine, oxycodone, or hydrocodone, while the non-opioid group was prescribed acetaminophen (i.e., Tylenol) or a nonsteroidal anti-inflammatory drug (i.e., Advil). If the prescription didn’t work, it would be changed, selecting from drugs that had been shortlisted. The participants were then asked to rate their pain every three months, on two scales: intensity and functionality (how easy it is to go about your day-to-day life).

Both the doctors and the patients knew their group assignment, since a patient’s expectation can influence how effective the drugs are, with a placebo-like effect.

“We found at the beginning of the study that patients who were enrolled really thought that opioids were far more effective than non-opioid medications,” she says.

Except this wasn’t the case: although patients were expecting opioids to be more effective, they weren’t. When the treatment was started, the opioid and non-opioid groups scored almost exactly the same on both intensity and functionality.

As some of the treatments were changed, both groups improved performance — but both were still equally effective in dulling the pain. Actually, opioids fared slightly worse, as they doubled the number of unpleasant side effects (dizziness, nausea, etc.).

“Opioids aren’t better than non-opioid medications,” Krebs summed up, “and we already knew from other research they are far more risky — and that the risk of death and addiction is serious.”

Researchers didn’t assess why this happens, though Krebs suspects it’s because in time, the body tends to build up a resistance to opioids.

This isn’t the first study to throw shade at long-term opioid use: just last year, a thorough research found that a cocktail of two over-the-counter drugs (ibuprofen and acetaminophen, commonly known as Advil and Tylenol) are more effective than heavy opioids in dealing with pain than heavy opioids.

The study concludes:

“Conclusions and Relevance Treatment with opioids was not superior to treatment with nonopioid medications for improving pain-related function over 12 months.

This study does not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain.”

Journal Reference: Krebs et al. ‘Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain’, JAMA.

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