Opioids are no more effective than common painkillers, study reveals

A team of researchers at the Minneapolis Veterans Affairs Health Care System has found that, for all their risks, opioids are no more effective than traditional non-steroidal anti-inflammatory drugs (NSAIDs) at easing chronic pain or at improving the extent to which this pain interferes with daily life.

The research brings into question the widely-held belief that such treatments somehow offer a unique benefit in the treatment of pain, in light of the escalating dependency crisis in the US with new data from the Centers for Disease Control and Prevention indicating that emergency room visits as a result of opioid overdoses rose by 30% between July 2016 and September 2017. In the Midwest, this increase was as high as 70%.

The government-funded study found that opioid medications such as oxycodone or morphine provided no observable benefit over painkillers like acetaminophen, ibuprofen, naproxen or topical analgesic lidocaine in easing pain in patients with arthritis or chronic pain of the back, knees or hips – they were even slightly less effective, with around twice as many reported side-effects.

The study assigned 240 chronic pain or arthritis patients either opioid or nonopioid medications as treatment, stepping up these therapies as needed to adequately manage the pain. After a year of treatment, it was discovered that around 60% in both groups were significantly more able to perform daily functions unfettered by their pain, suggesting the efficacy of both medications is comparable in this regard. However, significant improvement in pain intensity was reported by 54% of patients treated with nonopioids, compared to just 41% of those treated with opioid medications.

The researchers even noted that, because patients were aware of what they were being treated with, many would expect the opioid treatments to be more effective – even with this factor influencing the results, the opioid group still came in significantly lower in terms of efficacy.

"Overall, opioids did not demonstrate any advantage over nonopioid medications that could potentially outweigh their greater risk of harms […] Results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain," the team’s paper said, while study leader Dr Erin Krebs noted that the findings "will be surprising for a lot of people. Opioids have this reputation as powerful painkillers and I don’t think it is well deserved, at least for chronic pain."

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