Health Services Research & Development

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February 1, 2019

HSR&D Announces Best Research Paper of the Year Award Recipient

Erin E. Krebs, MD, MPH

Erin E. Krebs, MD, MPH

Erin E. Krebs, MD, MPH, is the recipient of the 2018 HSR&D Best Research Paper of the Year Award, which honors a single article or collection of articles resulting from one or more HSR&D- or QUERI-funded investigations. Research studies also must involve Veterans, with results that are important to Veterans’ health and care, and to the VA healthcare system.

Dr. Krebs’s article, “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,” was published in JAMA. Funded by HSR&D, this landmark study is the first randomized trial to report long-term pain, function, and quality of life outcomes of opioid therapy for chronic pain. Investigators randomized 240 VA patients with chronic back pain or osteoarthritis pain that was moderate-to-severe despite analgesic use. Veterans were recruited from 62 Minneapolis VA primary care clinicians (June 2013 to December 2015). Patients were then randomized to one of two intervention groups: opioid therapy or non-opioid medication therapy. Each intervention had its own prescribing strategy. In the opioid therapy group, the first step was immediate-release morphine, oxycodone, or hydrocodone/acetaminophen. For the non-opioid group, the first step was acetaminophen or a non-steroidal anti-inflammatory drug. The primary outcome was pain-related function over 12 months, and the main secondary outcome was pain intensity. Study findings show that opioids did not result in better pain-related function or pain intensity compared to non-opioid drugs in Veterans with chronic pain. These results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip/knee osteoarthritis pain.

Results of the trial drew extensive attention, including coverage by National Public Radio (e.g., “All Things Considered,” Opioids Don’t Beat Other Medications for Chronic Pain, March 6, 2018), The New York Times, and Scientific American magazine. The publication has been cited 37 times and is already a “highly cited paper” according to Web of Science. Study findings also were discussed during a Congressional Briefing on VA Opioid and Pain Management Research (May 24, 2018) and during VA Research Day on the Hill (June 19, 2018). In addition, her paper titled Effect of opioid vs. non-opioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain: the SPACE randomized clinical trial was the third most talked about article published by JAMA in 2018.

Dr. Krebs is part of HSR&D’s Center for Chronic Disease Outcomes Research (CCDOR). Her professional goal as a general internist and health services researcher is to improve the management of chronic pain in primary care. She currently leads an HSR&D nationwide study of VA patients on long-term opioid therapy and a Patient Centered Outcomes Research Institute (PCORI)-funded VA multisite trial testing approaches to improve pain and reduce opioid use among Veterans on high-dose long-term opioid therapy.

HSR&D thanks Dr. Krebs for her outstanding work and contributions to the literature which will help VA improve the safety of opioid prescribing both in and outside VA.




HSR&D also thanks the following Best Research Paper of the Year Nominees for their stellar work and contributions to the field of health services research.