Published: Thu, March 08, 2018
Medicine | By Earnest Bishop

Workers' comp and pain management experts discuss alternatives to opioids

Workers' comp and pain management experts discuss alternatives to opioids

USA government guidelines in 2016 said opioids are not the preferred treatment for chronic pain, and they recommend non-drug treatment or nonopioid painkillers instead.

Prescription opioid abuse has triggered national alarm, in part because the drugs have been linked to a rapid increase in drug overdose deaths - either because people misused the prescription drugs themselves, or because the painkillers served as gateway drugs that led people to try illicit drugs such as heroin.

"Results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain", the study authors concluded.

The VA trial addressed only long-term use, not opioid prescriptions for acute pain or immediately following medical procedures.

One possibility is that patients in the opioid group developed tolerance to the drugs, Krebs said.

This study found that side effects were more common among the people taking the opioids.

Despite the potential addictiveness of the opioids, the study reported no incidents of patients in the opioid group developing addictions or trying to "doctor shop" to gain additional medications.

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The trial - Strategies for Prescribing Analgesics Comparative Effectiveness, or SPACE - enrolled patients who were treated by the Minneapolis VA. Follow-up ended in 2016.

The opioid group took immediate-release morphine, oxycodone, or hydrocodone/acetaminophen (generic Vicodin).

He noted one limitation - most study participants were men, but Krebs said the results in women studied were similar. They switched to higher doses if needed or to long-acting opioids or fentanyl patches.

As some of the treatments were changed, both groups improved performance - but both were still equally effective in dulling the pain. The other group was given strictly nonopioids you can buy over-the-counter like acetaminophen (such as the drug Tylenol) or a nonsteroidal anti-inflammatory drug like ibuprofen. Few in either group used the strongest medicines.

Patients taking opioids reported a greater reduction in anxiety over 12 months, though the difference was small, Krebs said. Function scores improved in each group by about two points on an 11-point scale, where higher scores meant worse function.

Other research has shown that over-the-counter medicines can also work as well as opioids at treating short-term pain, including from broken bones, kidney stones or dental work. Both groups started out with average pain and function scores of about 5.5 points.

The randomized clinical trial included 240 participants from Veteran Affairs primary care clinics who were seeking treatment for chronic pain related to their back, hip, knee or osteoarthritis.

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