opioids less effective than Tylenol or NSAIDs for pain

It’s been a very bad couple of years for pharmaceutical painkillers. Study after study confirms that they don’t work while having significant side effects. The news has been bad for acetaminophen (Tylenol) and for NSAIDs like Aspirin. Now the bad news keeps coming in on opioids.

Conventional wisdom is that opioids are stronger, more effective painkillers. When Tylenol and Aspirin don’t work, turn to opioids. But research has already shown that opioids offer no additional benefit for pain like back pain.

And now the news gets worse because the evidence has gotten substantially stronger. A new study published in the prestigious Journal of the American Medical Association compared opioids to nonopioid painkillers in 234 people with moderate to severe chronic back pain or hip or knee osteoarthritis pain. The opioid group started with immediate-release morphine, oxycodone, or hydrocodone/acetaminophen; the nonopioid group started with acetaminophen or a NSAID.

There was no difference in the effectiveness of the two treatments over a one year period for pain-related function: that is, the opioids worked no better than the over-the-counter painkillers. Pain intensity actually improved significantly more in the group just given acetaminophen or NSAIDs. Adverse effects were significantly more common in the opioid group.

This study shows that, even though opioids are thought of as stronger painkillers, they are actually no better and, perhaps, even worse than over-the-counter painkillers. If they are not better, there is no justification for elevating to their higher risk, including addiction and death from overdose. The researchers concluded that the results “do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain.”

That opioids are no more effective than acetaminophen and NSAIDs is especially bad news since acetaminophen and NSAIDs are not very effective and not very safe.

JAMA 2018;319(9):872-882

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