No Gain

Study casts doubt on opioid effectiveness

By Elizabeth Foy Larsen

S2018_NoGain_Inline300As the opioid crisis generates daily headlines and takes center stage in public policy debates, University of Minnesota and Minneapolis VA Health Care System researchers have discovered something truly surprising about these highly addictive—and sometimes fatal—prescription drugs: When it comes to treating certain back, knee, and hip pain, they’re no more effective than nonopioid alternatives such as acetaminophen.

This research began when Erin Krebs, M.D., an associate professor of medicine at the U and the trial’s lead author, was a medical fellow in North Carolina. She noticed her patients with chronic back pain and arthritic hips and knees weren’t experiencing relief from commonly prescribed opioids, including morphine and oxycodone, even when they took the drugs for years. But when Krebs looked for studies about the long-term effectiveness of opioids, she was surprised to find there were none.

So, together with colleagues in Minnesota and Indiana, Krebs undertook a 12-month randomized trial involving 240 patients in VA primary care clinics. Half the group was treated with opioids, the other half with nonopioid pain relievers such as acetaminophen and topical lidocaine. The results showed that not only did the group receiving the nonopioids experience more improvement in pain intensity, they also had fewer side effects.

Medical experts hope those conclusions lead to a reevaluation of opioids—which have been heavily marketed as the most effective pain relief available—as a first-line treatment.

The study was published in March in the Journal of the American Medical Association.

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