Opioids Not Best Option for Back Pain, Arthritis, Study Finds

Opioids Not Best Option for Back Pain, Arthritis, Study Finds

Risky opioids are no better at controlling chronic back or arthritis pain than non-opioid drugs, including Tylenol or Motrin, new research finds.

With opioid overdose deaths rising in the United States, the findings suggest addictive medications like oxycodone (OxyContin) or morphine don’t have to be the first choice against crippling arthritis pain or chronic backache.

“We found that opioids had no advantages over non-opioid medications for pain, function or quality of life in patients with low back pain and osteoarthritis pain,” said study lead author Dr. Erin Krebs.

“This is important information for physicians to share with patients who are considering opioids,” added Krebs. She’s an investigator with the Minneapolis VA Center for Chronic Disease Outcomes Research.

Not only does the study suggest switching to opioids probably won’t help, but Krebs said the prescription painkillers will probably cause unpleasant side effects.

“Instead, they should consider trying other non-opioid medications or non-medication treatments,” Krebs suggested.

Long-term back pain hampers 26 million Americans aged 20 to 64, the American Academy of Pain Medicine has found. And roughly 30 million adults have pain from osteoarthritis, the wear-and-tear form of the disease, according to the U.S. Centers for Disease Control and Prevention.

In general, patients with chronic back or arthritis pain should first seek relief through exercise and rehabilitation therapies, said Krebs, who is also an associate professor of medicine at the University of Minnesota.

That’s because opioid medications, while promising significant pain control, come with substantial risks.

“The main harms are accidental death, addiction and physical dependence,” Krebs explained. “Everyone who takes opioids — even those who do not misuse them — is at risk for these serious harms.”

To compare the effectiveness of different means of pain relief, the new investigation enrolled 240 adults, average age 58, from June 2013 through 2015. All were receiving care for moderate to severe chronic back pain, or hip or knee arthritis pain.

None of the study participants had taken opioids on a long-term basis, the researchers noted.

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 theĀ Journal of the American Medical Association.

Common Painkillers Don’t Ease Back Pain, Study Finds

Common Painkillers Don’t Ease Back Pain, Study Finds

Painkillers like aspirin, Aleve and Advil don’t help most people with back pain, a new review finds.

The researchers estimated that only one in six people gained a benefit from taking these nonsteroidal anti-inflammatory drugs (NSAIDs).

Meanwhile, previous research has suggested that another common painkiller, Tylenol (acetaminophen), isn’t very useful either, the study authors added.

The findings raise the prospect that no over-the-counter painkillers really ease back pain, at least in the short term, and some may raise the risk of gastrointestinal problems.

“There are other effective and safer strategies to manage spinal pain,” said review author Gustavo Machado. He is a research fellow with the George Institute for Global Health in Sydney, Australia.

Back and neck pain are the leading cause of pain worldwide, the researchers said.

For the review, the investigators examined 35 studies on the use of NSAIDs to treat back pain. The studies most commonly examined the drugs ibuprofen (Advil), naproxen (Aleve), cox-2 inhibitors (but not Celebrex) and diclofenac (which is available in the United States, but not widely known).

The studies, which tracked about 6,000 people, “showed that commonly used NSAIDs have only small effects on pain relief and improvement of function,” Machado said. “Moreover, these small effects may not be perceived as important for most patients with spinal pain.”

The researchers also found that participants taking the drugs were 2.5 times more likely to experience gastrointestinal side effects, compared with those who took inactive placebos.

The review only included studies of people who took the drugs for an average of seven days.

“Unfortunately, there are no studies investigating the effects of NSAIDs for spinal pain in the medium-term (three months to 12 months), and the long-term (more than 12 months),” Machado explained.

Dr. Benjamin Friedman is an associate professor of emergency medicine with Albert Einstein College of Medicine and Montefiore Medical Center in New York City. He estimated that the painkillers might be even more ineffective than the review suggests, with fewer than one in 10 patients getting substantial relief.

What should patients with back pain do? Friedman said he often recommends the drugs even though they’re not likely to provide benefits.

“The happiest back pain patients I know are the ones who have found relief with some type of complementary therapy such as yoga, massage or stretching,” Friedman noted.

Study author Machado said, “Patients should discuss with their doctors whether they should take these drugs, considering the small benefits they offer and likelihood of adverse effects.”

As for whether opioid painkillers — such as Oxycontin — might work, he suggests that patients avoid them for back pain since research by his institute’s team has suggested they aren’t very effective either.

However, Friedman said they’re often prescribed for very brief periods for unbearable pain, along with physical therapy.

As for other suggestions, Machado points to guidelines that recommend patients with back pain remain active and avoid bed rest.

“There is also evidence that physical therapies and psychological therapies — such as cognitive behavioral therapy — bring benefits to these patients,” he said.

Also, Machado said, “people should focus on preventing back pain in the first place. Having a healthy lifestyle and engaging in physical activities is a very important way of achieving this.”

The review was published online Feb. 2 in the Annals of the Rheumatic Diseases.

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