For Arthritis Pain, Tylenol Works as Well as Opioids

A new study suggests opioids should not be used for chronic pain

Researchers found that at a year of followup, pain intensity was significantly better in the non-opioid group and that adverse medication-related symptoms were more common in the opioid group.

Researchers didn't assess why this happens, though Krebs suspects it's because in time, the body tends to build up a resistance to opioids.

"We already knew opioids were more risky than other treatment options, because they put people at risk for accidental death and addiction", Krebs told Reuters.

In the first randomized clinical trial to make a head-to-head comparison between opioids and other kinds of pain medications, patients who took opioids fared no better over the long term than patients who used safer alternatives. Participants were free to pursue physical therapy and other nonsurgical options to address their pain. Patients in both groups saw similar improvements in their quality of life. Both groups started out with average pain and function scores of about 5.5 points.

One possibility is that patients in the opioid group developed tolerance to the drugs, Krebs said.

US government guidelines in 2016 said opioids are not the preferred treatment for chronic pain, and they recommend non-drug treatment or nonopioid painkillers instead.

Patients taking opioids reported a greater reduction in anxiety over 12 months, though the difference was small, Krebs said.

Some people swear by opioids - it's the only thing that helps them get through the day, they'll argue.

About 42,000 drug overdose deaths in the 2016 involved opioids, including prescription painkillers, heroin and fentanyl. Medications were changed, adjusted and added within the assigned groups according to a patient's response.

Except this wasn't the case: although patients were expecting opioids to be more effective, they weren't. Many are still weighing whether to restrict dosages that prescribers can issue, and what to do for patients already dependent on opioids.

However, the findings should prompt doctors to reconsider the use of opioids as a first-line treatment for chronic musculoskeletal pain, they wrote.

"We found at the beginning of the study that patients who were enrolled really thought that opioids were far more effective than non-opioid medications", she says.
The report did not break down overdoses by type of opioid.

"We were keeping pretty close tabs on people", she said.

These patients explained what people should keep in mind about chronic pain when reading the study.

What the research discovered was that, over the year, there was not a significant difference in the final average BPI severity between the two groups. "Moving to opioids isn't likely to be the answer".



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