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3/9/2018 12:10:00 PM
Study: Chronic pain patients may do as well without use of possibly addictive opiates

Scott L. Miley, Herald Bulletin CNHI Statehouse Bureau

INDIANAPOLIS — Doctors who treat patients with hip or knee arthritis, among other chronic pain ailments, may want to cut back or eliminate prescriptions for long-term use of possibly addictive opiates, according to a study led by researchers with Indiana connections.

The 12-month study of 240 patients showed that treatment with opioids was not better than treatment with non-opioids to improve painrelated functions.

“People got just as good pain relief if you used nonopiate pain medicines and somewhat fewer side effects with chronic pain,” Dr. Kurt Kroenke said.

“We probably should not be starting people with chronic pain on opiates because we should use the other pain medicines we have,” he said, adding, “The bottom line in chronic pain is, you should probably use a combination of pain medicines that are not opiates as well as treatments combined with medicine that are non-pharmacological.”

For example , Kroenke said, prescribers could consider non-medicinal treatment including massage, exercise, acupuncture and yoga.

Half of the study participants were given opioids such as morphine, oxycodone and hydrocodone/ acetaminophen. The others were given acetaminophen followed by non-steroidal anti-inflammatory drugs.

In essence, opiates may be no better than Tylenol in treating long-term chronic pain.

“But for the five to seven million Americans on opiates, this study is not evidence we should be taking them off,” Kroenke added. “For many people who are on opiates, we should have discussions about it. We should talk about ways they should either get off opiates or reduce the dose.” Kroenke is a researcher with Roudebush Veterans Affair Medical Center in Indianapolis, where he is also a physician with the Indiana University School of Medicine. The study was led by Dr. Erin E. Krebs, who was an internist in Indianapolis before leaving to work with the University of Minnesota Medical School and become a researcher with the Minneapolis Veterans Affairs Health Care System.

If opiates don’t work better than less risky drugs, there’s no reason to use them given “their really nasty side effects — death and addiction,” Krebs told The Associated Press.

A report released Tuesday by the Centers for Disease Control and Prevention found emergency rooms saw a big jump in overdoses from opioids in 2017. Opioid overdoses increased 30 percent late last summer, compared to the same three-month period in 2016. The biggest jumps were in the Midwest and in cities, but increases occurred nationwide.

Indiana saw a 25-49 percent increase in opioid-related emergency department visits, according to the study.

Also conducting the study was Matthew J. Bair with the Roudebush Veterans Affairs Center in Indianapolis.

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