Author: Lorenzo Di Francesco, MD, FACP, FHM
Opioids are not better than nonopioid drugs for relieving back pain or pain related to hip or knee osteoarthritis, a JAMA study finds.
Nearly 250 patients with moderate-to-severe chronic back pain or hip or knee osteoarthritis pain were randomized to receive either opioids or nonopioids. In the opioid group, patients began taking immediate-release opioids and could be stepped all the way up to fentanyl patches (maximum daily dosage, 100 morphine-equivalent mg). For nonopioids, patients began with acetaminophen or nonsteroidal anti-inflammatory drugs and could be stepped up to drugs requiring authorization from the clinic, including pregabalin.
The primary outcome — pain-related function — was similar between the groups over 12 months. Pain intensity, a secondary outcome, was significantly better with nonopioids (improvement of 0.5 on a 10-point scale). Opioid recipients had more medication-related symptoms.
The authors conclude that their findings do not support starting opioids in such patients.