Study: Opioids have no pain-relieving benefits over other, safer drugs
For years, doctors turned to opioid painkillers as a firstline treatment for chronic back pain and aches in the joints. Even as the dangers of addiction and overdoses became clearer, the drugs’ pain-relieving benefits were still thought to justify their risks.
Now researchers have new, hard evidence that challenges this view.
In the first randomized clinical trial — the gold standard design for research — to make a headto-head comparison between opioids and other kinds of pain medications, patients who took opioids fared no better over the long term than patients who used safer alternatives.
“There was no significant difference in pain-related function between the two groups over 12 months,” researchers reported Tuesday in the Journal of the American Medical Association.
By some measures, the people using non-opioid drugs such as Tylenol, ibuprofen and lidocaine experienced more pain relief than people using medications like morphine, Vicodin and oxycodone — though the differences weren’t large enough to be considered statistically significant. Patients in both groups saw similar improvements in their quality of life.
The results echo less rigorous studies and bolster guidelines against routine use of opioids for chronic pain.
The findings cast doubt on the medical community’s “standard approach” of using opioids to manage chronic musculoskeletal pain, the researchers found.
“Overall, opioids did not demonstrate any advantage over nonopioid medications that could potentially outweigh their greater risk of harms,” wrote the team led by Erin Krebs of the Minneapolis Veterans Affairs Health Care System’s Center for Chronic Disease Outcomes Research.
“The fact that opioids did worse is really pretty astounding,” said Roger Chou, an internist at Oregon Health & Science University and a co-author of Centers for Disease Control and Prevention guidelines on opioid use for chronic pain, who was not involved in the recent study. “It calls into question our beliefs about the benefits of opioids.”
The findings run counter to years of medical practice in the U.S., where more so than in other countries, opioids have been prescribed to millions of patients for chronic pain over the years — even though data on their longterm effectiveness was lacking. Doctors, however, are pulling back now.
Ms. Krebs and her coauthors said the impetus for their clinical trial was the escalating opioid crisis, which now claims about 115 American lives each day, according to the Centers for Disease Control and Prevention. The number of overdose deaths linked to prescription drugs like oxycodone and hydrocodone has increased by a factor of four since 1999, the CDC says.