A Study Found That Opioids Don't Work Best for Some Types of Chronic Pain. Here's What Patients Think.

A new study claims to offer evidence that opioids don’t work better than non-opioid pain medication for some types of chronic pain, and patients have a lot to say about it.

The study, published yesterday in the Journal of the American Medical Association, looked at 234 patients from Veterans Affairs clinics in Minneapolis with “moderate to severe” chronic back pain or hip or knee osteoarthritis pain from December 2015 to December 2016. Patients were randomly assigned to an opioid or non-opioid group (participants knew which group they were in and what medications they were taking).

The opioid group took immediate-release morphine, oxycodone, or hydrocodone/acetaminophen (generic Vicodin). They could switch to higher doses or long-acting opioids or fentanyl patches if desired. The non-opioid group took acetaminophen (paracetamol) or a nonsteroidal anti-inflammatory drug (NSAID), and could switch to higher doses or prescription non-opioid pain pills. However, most participants did not ultimately use the strongest pain relief options.

Participants reported how their pain changed through questionnaires. On an 11-point scale in which the participants’ average pain function and intensity was 5.5 at the beginning of the study, after 12 months, the two groups did not differ significantly on pain-related function. However, the average pain intensity dropped two points in the non-opioid group and slightly less in the opioid group. Adverse medication-related symptoms were more common in the opioid group.

The study has some limitations. Only 32 women participated in the study (though lead author Erin Krebs said the findings were similar for both groups). The mean age was 58.3 years, meaning few young people were included. While there are many conditions that can cause chronic pain, like autoimmune diseases, Ehlers-Danlos syndrome and fibromyalgia, only back pain and hip or knee pain from osteoarthritis were included in the study. And patients were only recruited from VA clinics, which means their experience with chronic pain may not be representative of all chronic pain patients.

While the study may have useful implications for the specific type of chronic pain studied, the study is being touted by many as evidence that in general, opioids aren’t more effective than over-the-counter and non-opioid pain medication — which many people with chronic pain say is incorrect. Articles about the study include headlines like “Opioids no better than Tylenol for treating chronic pain, study finds” and “Prescription opioids fail rigorous new test for chronic pain.” As a result, many chronic pain patients have taken to social media to share their thoughts on the study and conversation around it — especially since the study could be used to support tougher restrictions on opioids amid the opioid crisis.

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

For some people with a very small set of issues, Tylenol and super pricy Lyrica help. Intractable pain patients don’t have ‘some arthritis‘. We have IC, RA, Lupus, Arachnoiditis, etc. Don’t lump all chronic pain sufferers under the same umbrella.

— Ava ⭐ (@AvaSkovdottir) March 6, 2018

I have CRPS, the most painful condition on the McGill Pain scale. Tylenol doesn’t even begin to touch my pain or make it so I can even get out of bed each day.

— Mkandmj8 (@MarkEwi20815682) March 7, 2018

The price of other medications that help with pain needs to drop drastically. Don’t push people off opioids until there is an alternative that’s just as affordable as opioids.

— Robyn (@Rockin2012Robin) March 7, 2018

I’m 36 with two failed back surgeries and I can tell you this study is incorrect. I take opioids, but as prescribed, and I can’t walk or function well without them. This narrative is really starting to screw chronic pain sufferers like me

— Ryan (@Imall4america) March 6, 2018

I’ve had disc surgery 3 times and a 3 level fusion and for people with actual nerve pain this is absolute b.s. although I don’t take pain meds anymore there were points where Advil just doesn’t cut it

— James Ova (@bscova89) March 6, 2018

Sheesh…yeah, for “chronic back pain and aches in the joints” ONLY.

Newsflash: There’s OTHER reasons why people can be in pain and for a lot of them, opioids DO work best.

Also NSARs? Require PPIs for long-term use or hello stomach-ulcers and gastric bleeding. ???? https://t.co/ut7ICptF65

— Julia Heiler (@AndarthaRasri) March 7, 2018

As someone who has chronic pain, opioids are better for acute treatment. Long term they stop working, dependence rises, etc. There are better alternatives to those and NSAIDs, which don’t work for everyone either. I’ve never met a Tylenol that I liked.

— Moriah Pariah (@MoriahEGN) March 7, 2018

This test for chronic pain fail to say that long term use of NSAIDS cause kidney damage & Tylenol causes liver damage. Some ppl need opioids for pain, it doesn’t mean everyone becomes addicted. MDs have the responsibility to monitor monthly prescriptions. PT & activity help.

— Debbie Holland (@deb9455) March 7, 2018

Opioids are critical to a certain set of the population. We must not make them suffer.
We also need legal, affordable cannabis. You can’t win the fight without it, so let’s get it done now.

— citizen2763 (@Stl_farmer) March 7, 2018