The Strategies for Prescribing Analgesics Comparative Effectiveness (SPACE) HSR&D-funded study compared opioid therapy versus non-opioid medication therapy over 12 months for primary care patients with chronic back pain or hip or knee osteoarthritis pain. Investigators identified 240 Veterans with chronic pain (nearly every day for ≥6 months) that was moderate-to-severe despite analgesic use. Veterans were recruited from 62 Minneapolis VA primary care clinicians from June 2013 to December 2015. In this randomized controlled trial, patients were randomly assigned to one of two intervention groups: opioid therapy or non-opioid medication therapy. 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. Findings showed that, overall, opioids did not demonstrate any advantage over non-opioid medications that could potentially outweigh their greater risk of overdose and other serious harms. Results do not support the initiation of opioid therapy for moderate to severe chronic back pain or hip/knee osteoarthritis pain.
Findings from this research are already being discussed in the Washington Post (“Prescription opioids fail rigorous new test for chronic pain”), in which Geriatrics Chief Dr. David Reuben, UCLA’s School of Medicine, stated “This is a very important study. It will likely change the approach to managing long-term back, hip and knee pain.” NPR also highlights the study in their article “Opioids don’t beat other medications for chronic pain.”
Krebs E, Gravely A, Nugent S, et al. 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. JAMA. March 6, 2018;319(9):872-882.