Opioids Are Nonsuperior to Nonopioids for Common Pain

Opioids are nonsuperior to nonopioids for the treatment of moderate to severe chronic back pain or hip or knee osteoarthritis (OA) pain, according to findings from a recent study.

In the SPACE Randomized Clinical Trial, researchers evaluated 265 patients with moderate to severe chronic back pain or hip or knee OA pain despite analgesic use. The trial was carried out from June 2013 through December 2015, and follow-up lasted through December 2016.
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Ultimately, 240 patients were randomly assigned to treatment with either opioid (immediate-release morphine, oxycodone, or hydrocodone/acetaminophen) or nonopioid medication therapy (acetaminophen [paracetamol] or a nonsteroidal anti-inflammatory drug).

Medications were changed, added, or adjusted as needed. In addition, each intervention was followed with a treat-to-target strategy for the improvement of pain and function.

A total of 234 (97.5%) completed the trial. Results demonstrated that there was little difference between intervention groups regarding 12-month pain-related function, with mean 12-month Brief Pain Inventory (BPI) interference scale scores of 3.4 for opioid-treated patients and 3.3 for nonopioid-treated patients.

Notably, the researchers observed significantly more improvement in 12-month pain intensity among nonopioid-treated patients compared with opioid-treated patients (BPI severity: 3.5 for nonopioids, 4.0 for opioids).

Adverse treatment-associated symptoms occurred more commonly in opioid-treated patients. Mean 12-month symptoms were calculated 1.8 in opioid treatment patients and 0.9 in nonopioid-treated patients.

“Treatment with opioids was not superior to treatment with nonopioid medications for improving pain-related function over 12 months,” the researchers concluded. “Results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain.”

—Christina Vogt

Reference:

Krebs EE, Gravely A, Nugent S, et al. Effect of opioid vs nonopioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain: the SPACE randomized clinical trial. JAMA. 2018;319(9):872-882. doi:10.1001/jama.2018.0899.