Study 10: “Effect of opioid vs nonopioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain” Krebs et al.
This randomized controlled trial included 240 patients with low back pain or osteoarthritis and randomized them to receive opioids or receive non-opioid medication. The opioid prescription was titrated to a maximum daily dosage of 100 morphine-equivalent mg. The nonopioid prescription was paracetamol (acetaminophen) and NSAIDs, if these were insufficient pain relief then they were followed by amitriptyline, gabapentin and topical analgesics, which were followed by pregabalin, duloxetine and tramadol. This study found no significant clinically important differences in pain-related function or pain intensity at 3-, 6-, 9-, or 12 month follow up. The key takeaway from this study is that non-opioid prescription may be equivalent to opioid prescription for low back pain and osteoarthritis. Full study available at: https://jamanetwork.com/journals/jama/fullarticle/2673971
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