Professional guidelines increasingly discourage the use of opioid painkillers as first-line treatment for chronic pain because of the risk of addiction and overdose deaths. On top of that, opioids may be no more effective for common types of chronic musculoskeletal pain than other drugs, according to a clinical trial in the Journal of the American Medical Association in March 2018.
The study involved 240 patients from Veterans Affairs clinics who had moderate to severe chronic back pain or hip or knee osteoarthritis. Half were given opioid drugs (such as morphine, oxycodone, and hydrocodone), the other half non-opioid drugs (such as acetaminophen, nonsteroidal anti-inflammatory drugs like ibuprofen, certain antidepressants, and topical analgesics); stronger drugs were added when needed. After 12 months, there was no difference in pain-related function or quality of life between the two groups. In fact, pain intensity was reduced slightly more in the non-opioid group.
The results of this and other studies suggest that the long-term use of opioids to treat chronic non-cancer pain (notably back pain or pain from hip or knee arthritis) should be the exception rather than the rule.
A version of this article first appeared in the UC Berkeley Wellness Letter.