As the nation and the medical establishment wrestles with a burgeoning opioid/opiate/heroin overdose epidemic, the Journal of the American Medical Association (JAMA) published the results of a new study which seems to indicate a possible solution to the over-prescribing of opiates. While a handful of providers disagree with some of the study’s findings, preliminary data shows opiates work no better than over-the-counter pain medicines for some types of chronic pain.
The researchers’ primary question was “for patients with moderate to severe chronic back pain or hip or knee osteoarthritis pain,” how does opioid medication compare with nonopioid medication result in managing chronic pain?
To answer the question a clinical trial was initiated involving 265 military veterans (receiving treatment from the Department of Veterans Affairs medical facilities) whose responses to a questionnaire were charted over a 12-month period. Initially, 25 of the participants withdrew from the study for unknown reasons.
The objective of the study was to “compare opioid vs nonopioid medications over 12 months on pain-related function, pain intensity, and adverse effects.”
The total number of participants were divided in two. The first group was given opioids, the second group was given readily available over-the-counter medicines.
Within the opioid group, “the first step was immediate-release morphine, oxycodone, or hydrocodone/acetaminophen” some of the same drugs for which tens of thousands of U.S. patients are using to the point of overdose and subsequent deaths.
For the non-opioid group, the medicines administered were “acetaminophen” (AKA Tylenol or paracetamol) or a “nonsteroidal anti-inflammatory drug” (such as ibuprofen, AKA Advil, Aleve, etc.) According to the JAMA study, “medications were changed, added, or adjusted within the assigned treatment group according to individual patient response.”
Patients were then asked to describe their pain using the Brief Pain Inventory [BPI], a questionnaire assessing the presence of pain experienced. Additionally, they were asked to describe their “pain intensity” (BPI severity scale). For both BPI scales, the primary adverse outcome was “medication-related symptoms.”
At the end of the 12-month period of study, surprisingly, the non-opioid group fared better. “Pain intensity was significantly better in the nonopioid group over 12 months,” concluded the study with respondents reporting lower levels of chronic pain using medicines which are readily available over-the-counter in pharmacies. Additionally, the respondents who were not using opioids reported fewer side effects.
“Adverse medication-related symptoms were significantly more common in the opioid group over 12 months,” the study published in the Journal of American Medical Association reported. Aside from the obvious life-threatening side effects, common side effects of opioids include constipation, nausea, drowsiness, and itching.
The study concluded not only did commonly found over-the-counter medications work better than opiates, they had fewer negative side effects. In chronic pain conditions where prescribers might normally write scripts for opioids, initiation of opioid therapy for moderate to severe chronic back, hip, or knee pain might best be avoided.
Treatment with opioids was not superior to treatment with nonopioid medications for improving pain-related function over 12 months. Results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain.
Still, those who are in the business of managing pain, disagree with the study and adamantly contend there is still a place for opiates in pain management therapy. We consulted with a pain-medication provider located in the Mid-West who wishes to remain anonymous. His state is one in which pain-management doctors have been targeted for increased state-level regulation. We will call him Dr. Kim.
Kim says his patients simply need something much more powerful to deal with their pain. He, too, uses the BPI scale and states the real-world numbers he sees in his clinic do not compare to the study’s findings.
I disagree...without narcotics...my pain patients with back pain...wouldn’t be able to function. They wouldn’t be able to do what we call activities of daily living.
While Dr. Kim disagrees, the fact that dozens of people successfully treated their chronic pain with something far safer than opioids with fewer side effects, and faster recovery, should not be overlooked.
It is also important to point out that access to cannabis—which arguably works better than opioids and over-the-counter medicines—is prohibited by the DEA’s classification of a plant as a drug. Currently, cannabis is a Schedule-I narcotic, even though it is a plant.
Dr. Kim is aware of the pain-relieving properties of cannabis but is disallowed by the DEA from recommending his patients try cannabis. Instead, he’s forced to prescribe medicines which are at the center of the opioid epidemic.
The results from the JAMA study should give providers the justification they need to prescribe over-the-counter medicines at prescription strength instead of extremely addictive opioids, knowing full well, in certain cases and conditions, not only do the OTC meds work better, but account for fewer side effects.
The use of opiates is still an option for providers to prescribe, but might better be prescribed by physicians like Dr. Kim, who deal mostly with patients who may have tried other options but still find themselves in pain.