Study questions effectiveness of Rx opioids

March 08--Prescription opioids have come up short of the best option for chronic pain in a new study published in the Journal of the American Medical Association.

The yearlong randomized study led by a Veterans Affairs physician found that opioids worked no better than over-the-counter drugs or other nonopioids at reducing problems with walking or sleeping, and they provided slightly less pain relief. VA clinic patients with arthritis or back pain were assigned generic opioids, including Vicodin, oxycodone or fentanyl patches, or nonopioids which included generic Tylenol, ibuprofen and prescription pills for nerve or muscle pain.

U.S. government guidelines said opioids were not the preferred treatment for chronic pain relief in 2016, and prescribing rates have dropped slightly in recent years as the country responds to an addiction epidemic that kills 115 people every day, according to the federal Centers for Disease Control.

Bassett Health Care Network doctors agreed that while opioids are still necessary drugs, attitudes about prescribing are shifting with increased scrutiny.

"It takes a long time to get to that point because we have to educate both the medical community and patients," said pharmacist Amanda Winans, who is co-chair of the network's pain management committee.

Anti-inflammatory medications are often underestimated for their ability to control pain, she explained, and antidepressants provide relief in some cases. Physical exercise has proven especially effective for chronic back pain, and other rehabilitative physical therapies such as acupuncture can be helpful.

"I think this reconfirms what the medical community has suspected for some time," she said of the JAMA study.

Winans also noted that doctors are trying to change patients' expectations about their pain levels and emphasize functionality. Patient information packets have been changed to reflect that having no pain isn't always realistic.

Chief of surgery Dr. Nicholas Hellenthal said that the hospital is in the process of standardizing the number of opioid pills prescribed after 19 common operations.

"As residents there was no education on this," he said, and practices thus varied. Patients also have differing attitudes about taking opioids.

The goal now is to have fewer pills in the community, Hellenthal said. Medication take-back boxes at hospital locations were installed this year and are already well-utilized.

Erin Jerome, staff writer, may be reached at (607) 441-7221, or at ejerome@thedailystar.com. Follow her on Twitter at @DS_ErinJ .

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