By this measure, both groups improved equally over the course of the year, based on a 10-point scale with higher scores indicating worse impairment.
With opioids, scores declined from an average of 5.4 at the start of the study to 3.4 a year later. With other drugs, scores dropped from 5.5 to 3.3.
Patients also rated pain intensity on a 10-point scale with higher scores indicating more severe symptoms, and non-opioid drugs worked slightly better on this measure.
In both groups, patients initially rated their pain intensity at 5.4, but scores dropped to just 4.0 with opioids and fell to 3.5 on the other drugs.
One limitation of the study is that people knew which medications they were prescribed, which might affect how patients reported their own pain severity and daily functioning, the authors note.
Even so, the results offer fresh evidence that opioids may not be worth the addiction risk when treating chronic pain, says Marissa Seamans, a researcher at Johns Hopkins Bloomberg School of Public Health in Baltimore who wasn’t involved in the study.
“There is increasing evidence that non-opioid pain relievers are just as (if not more) effective than opioids for chronic non-cancer pain,” Seamans says by email.
Patients should only consider opioids if alternatives like exercise, physical therapy or other medications don’t help, said Dr. Chad Brummett, a researcher at the University of Michigan in Ann Arbor and co-director of the Michigan Opioid Prescribing Engagement Network.
“Prior to beginning opioids, patients not responsive to these non-opioid medications should ideally be evaluated by a pain specialist before starting chronic opioid therapy,” Brummett says by email.
- 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 Mar 6;319(9):872–882. doi: 10.1001/jama.2018.0899.