Thursday, 21 June, 2018

Opioids no better than Tylenol for treating chronic pain

Getty Images  John Moore Getty Images John Moore
Ben Pena | 08 March, 2018, 10:15

There is limited evidence regarding long-term outcomes for treatment of chronic pain with opioids compared with nonopioid medications. The number of overdose deaths linked to prescription drugs like oxycodone and hydrocodone has increased by a factor of four since 1999, the CDC says.

"Treatment with opioids compared with non-opioid medications did not result in significantly better pain-related function over 12 months", Krebs and her colleagues concluded.

However, the findings should prompt doctors to reconsider the use of opioids as a first-line treatment for chronic musculoskeletal pain, they wrote. And she said noted that there are a variety of nonopioid drugs to try if one type doesn't work.

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

Except this wasn't the case: although patients were expecting opioids to be more effective, they weren't.

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. Follow-up ended in 2016.

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As some of the treatments were changed, both groups improved performance - but both were still equally effective in dulling the pain.

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

This isn't the first study to throw shade at long-term opioid use: just a year ago, a thorough research found that a cocktail of two over-the-counter drugs (ibuprofen and acetaminophen, commonly known as Advil and Tylenol) are more effective than heavy opioids in dealing with pain than heavy opioids. They switched to higher doses if needed or to long-acting opioids or fentanyl patches. However, hospitalizations and emergency room visits to deal with pain medications were similar in both groups, as were rates of drug misuse. When the treatment was started, the opioid and non-opioid groups scored nearly exactly the same on both intensity and functionality.

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.

Using a scale that rated pain severity from 0 to 10, patients in the opioid group reported an average score of 4.0 and patients in the nonopioid group had an average score of 3.5.

The study was one of the first comparative trials of opioid painkillers in the United States - assigning 120 military veterans to take opioids for chronic joint pain for one year, and another 120 to manage their pain with alternatives such as acetaminophen and nonsteroidal anti-inflammatory drugs.

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