Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain

Abstract

clinicaltrials.gov Identifier: NCT01583985.

Prescribing wellness: comprehensive pain management outside specialist services

“…During a year of collaborative care, the initiation of opioids failed to improve function, but caused more adverse effects and marginally worse pain intensity. 19 Adverse effects include opioid-induced hyperalgesia and tolerance which cause a perceived increase in pain and need for dose escalation. Recent animal and human studies indicate that opioids may actually contribute directly to chronic pain.…”

Managing twin crises in chronic pain and prescription opioids

“…However, stable doses of opioids can provide durable pain relief with limited side effects for a subgroup of people 9. Consequently, a poor risk:benefit ratio overall may obscure a positive profile in some patients with chronic pain.…”

Opioids versus non-opioids for chronic musculoskeletal pain

“…It is thought that long-term opioid therapy has become a standard approach to managing chronic musculoskeletal pain, despite a lack of high-quality data on benefits and harms 3. The risks associated with opioid use have highlighted a need for clinical guidance on opioid prescribing 4…”

“…A recently published study has compared the effect of opioid with non-opioid medication over 12 months on pain-related function, pain intensity and adverse effects 3. It included 240 USA military veterans (mean age 58 years, 87% men), with moderate to severe chronic back pain or hip or knee osteoarthritis pain despite analgesic use, randomised to either opioid or non-opioid treatment.…”

“…Each intervention had its own prescribing strategy that included multiple medication options in three steps 3. In the opioid group the first step was immediate-release morphine, oxycodone or hydrocodone/paracetamol.…”