group had less pain intensity and the opioid group had more side effects,” such as constipation, fatigue and nausea, Krebs says. The study didn’t explore why, but Krebs believes the reason is opioid tolerance.“Within a few weeks or months of taking an opioid on a daily basis, your body gets used to that level of opioid, and you need more and more to get the same level of effect,” she says. “This study adds the long-term evi- dence that shows that opioids really don’t have any advantages in terms of pain relief that might outweigh the known harms that they cause.” People suffering with chronic back or arthritis pain, are better off not starting on opioids, Krebs says “Medications have some role, but they really shouldn’t be the primary way we are treating chronic pain,” she says. “For osteoarthritis pain, the strongly recommended treatments are exercise treatments,” she says, and it’s import- ant to maintain a healthy weight. “The same things go for back pain,” she says. For that, pain management experts recommend exercise, rehabil- itation treatments, yoga and cognitive therapies, among others.
of a lack of scientific evidence com- paring the effectiveness of opioid versus non-opioid medications. “Long-term opioid therapy became a standard approach to managing chronic musculoskeletal pain despite a lack of high-quality data on benefits and harms,” the JAMA article notes. Patients were then randomly placed into two groups. In the first group, pa- tients would be prescribed an opioid medication, whereas in the second group, they would be prescribed a non-opioid alternative medication. Placebo Effect Studied “The studies that we had out there were short-term studies and mostly compared opioids to placebo medi- cations, Krebs told NPR. “From those studies, we knew that opioids can improve pain a little bit more than a placebo, or sugar pill, in the short term, but that’s all we knew,” says Krebs, a Core Investigator at the Minneapolis VA Center for Chronic Disease Outcomes Research and Associate Professor of Medicine at the University of Minnesota. Doctors and patients knew what group they were in, Krebs says.“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. But after about nine months, even with those expectations, the non-opioid group reported their pain was slightly less severe than the opioid group. At the end of the year, “there was re- ally no difference between the groups in terms of pain interference with ac- tivities. And over time, the non-opioid
Source: National Insititutes of Health (NIA)
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