From the Journals

Nonopioid analgesics have no major disadvantages vs. opioids for chronic pain

Key clinical point: Opioids and nonopioid analgesics provided similar improvements in pain-related function for patients with chronic pain.  
Major finding: Patients taking opioids did not show significant improvement in pain-related function, compared with those taking nonopioids (P = .58). 
Study details: A 12-month, randomized trial of 240 patients with chronic back, knee, or hip pain, gathered from a Veterans Affairs clinic between June 2013 to December 2015.  
Disclosures: The study was funded by an award from the U.S. Department of Veterans Affairs Health Services Research and Development Service. The investigators reported no relevant disclosures. 
Source: Krebs E et al. JAMA. 2018;319(9):872-82



Patients treated with opioids for moderate to severe chronic back pain or knee or hip osteoarthritis pain saw no significant improvement when results were compared with treatment using acetaminophen or nonsteroidal anti-inflammatory drugs in the randomized SPACE study.

These findings may help restructure how physicians treat patients with chronic pain in order to decrease the risk of opioid addiction in a population that is particularly susceptible.


“Long-term opioid therapy became a standard approach to managing chronic musculoskeletal pain despite a lack of high-quality data on benefits and harms,” wrote Erin E. Krebs, MD, MPH, core investigator at the Minneapolis Veterans Affairs Center for Chronic Disease Outcomes Research, and her colleagues. “Rising rates of opioid overdose deaths have raised questions about prescribing opioids for chronic pain management.”

In the 12-month SPACE (Strategies for Prescribing Analgesics Comparative Effectiveness) trial published March 6 in JAMA, the investigators reported randomizing a total of 240 patients to treatment with immediate-release opioids (morphine, oxycodone, or hydrocodone/acetaminophen) or acetaminophen or nonsteroidal anti-inflammatory drugs. The patients came from the Minneapolis VA system between June 2013 and December 2015. Patients in the opioid group were on average 57 years old, while those in the nonopioid group had an average age of 60 years. Men comprised 87% of all patients, and both groups were predominantly white (86%-88%) with chronic back pain (65%). The investigators excluded patients with physiological opioid dependence from ongoing opioid use.

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