Opioid medications achieve no better results than non-opioid medications for long-term treatment of chronic back pain and osteoarthritis pain, according to researchers from the Minneapolis VA Health Care System.
Findings of the study were presented in April at the SGIM 2017 Annual Meeting, in Washington, D.C., and is said to be the first completed randomized controlled trial of long-term opioid therapy for chronic pain.
“This study is pertinent to managed care executives because opioid therapy is widely prescribed and not as effective as non-opioid pain treatment options,” says Erin Krebs, MD, the chief author, who holds appointments at the Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System.
The randomized study of 240 veterans compared opioid therapy versus non-opioid medication therapy over 12 months. Patients treated for back, hip, or knee pain at VA primary care clinics were identified through searches of the electronic medical record and screened by telephone for eligibility. Patients with chronic back pain or hip or knee osteoarthritis pain of at least moderate severity despite analgesic use were eligible. Eligible patients who consented and completed a baseline assessment visit were randomized to either the opioid therapy arm or the non-opioid medication therapy arm.
Multiple medications available on the formulary were included in each arm. Both interventions (opioid therapy and non-opioid therapy) were delivered using a telecare collaborative management model, with pain medication management provided for 12 months; medications were tailored to patient preferences and adjusted within the assigned treatment arm to achieve improvement in pain and individual functional goals.
Outcomes were evaluated by masked assessors at three, six, nine, and 12 months after enrollment. The primary outcome was the Brief Pain Inventory (BPI) interference scale, a patient-reported measure of pain interference with function. The BPI severity scale was used to assess pain intensity and a checklist of adverse symptoms was used to evaluate side effects of medication therapy.
“We found no significant advantage of opioid therapy compared with non-opioid medication therapy over 12 months,” Krebs says. “More patients treated with non-opioid medications had significant improvement in pain. Patients treated with opioid medications had more medication side effects. In the context of prior studies that have documented higher rates of serious harms among patients receiving opioid therapy, our findings support the recent CDC recommendation that non-opioid therapies are preferred over opioids for chronic pain.”