Opioids not superior pain relievers

A shot of pills of many colors.

A big obstacle to stemming the tide of addiction to opioid pain relievers has been the doubt that nonopioid drugs could provide similar relief. But in a striking new study led by University of Minnesota/Minneapolis VA Health Care System researcher Erin Krebs, nonopioids not only weren’t inferior, but in some ways tested superior, to opioids.

The 12-month study followed 240 patients with chronic, intense pain—either back pain or osteoarthritis pain in hips or knees. The patients were treated either with opioids or with nonopioid pain relievers like acetaminophen, topical lidocaine, nortriptyline, and meloxicam. 

“We designed the study to identify the medication regimen with the best balance of benefits and tolerability for each patient,” says Krebs, an associate professor of medicine. “It allowed treatment with a range of low to moderately high opioid dosages.”

When the results came in, the patients given nonopioid medications showed a small but significantly better improvement in the intensity of their pain compared to those given opioids. 

Also, patients given nonopioids experienced significantly fewer side effects than those given opioids. And while pain-related loss of function was eased for most patients in both groups, opioid treatment was not superior.

“Overall, opioids did not demonstrate any advantage over nonopioid medications that could potentially outweigh their greater risk of harms,” says Krebs.

The study appears in the Journal of the American Medical Association. Krebs is now leading a new nine-state study on how to improve care for people who are already taking long-term high-dose opioids and still having severe pain.

University of Minnesota, Twin Cities