JAMA Study: Opioids No Better Than Nonopioids in Improving Pain-Related Function, Intensity for Chronic Back Pain, Hip/Knee OA

APTA’s #ChoosePT opioid awareness campaign makes the case that opioids simply “mask” pain—but a new study in JAMA has concluded that the drugs probably don’t even do that much, at least not any more effectively than nonopioid medications. The research, which focused on individuals with chronic back pain or hip or knee osteoarthritis (OA) pain, led authors to an unequivocal conclusion: there’s no support for opioid therapy for moderate-to-severe cases of those types of pain.

The published findings are based on a study of 240 randomized patients in the Minneapolis, Minnesota, Veterans Affairs (VA) health care system who reported chronic back pain or knee or hip OA pain, defined as daily moderate-to-severe pain for 6 months or more with no relief provided by analgesic use. Participants were divided into 2 groups: 1 that received an opioid regimen, and a second group that received nonopioid drugs.

To more closely resemble real-world treatment, researchers used a “treat-to-target” approach that stepped up the drugs as needed for participants to reach identified goals. The opioid regimen began with immediate-release morphine, hydrocodone/acetaminophen, and oxycodone, but the regimen could advance to sustained-action morphine and oxycodone, and on to transdermal fentanyl. The nonopioid approach began with acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDS), but it could move on to topical analgesics and finally to drugs requiring prior authorization (such as pregabalin and duloxetine), including tramadol. All participants also were permitted to pursue nondrug treatment during the study, but researchers did not evaluate data related to those treatments.

Full story at APTA

AGs From 37 States Call for Better Insurance Coverage for Nonopioid Pain Treatment

Attorneys general (AGs) from 37 states have let the insurance industry know that the fight against the nation’s opioid crisis won’t be won unless health care providers are encouraged to prioritize nonopioid pain management options, including physical therapy, over opioid prescriptions for the treatment of chronic, noncancer pain. But that encouragement won’t have much impact unless it’s accompanied by payment coverage policies that make the nonopioid approaches more feasible to pursue, they write.

In a letter to America’s Health Insurance Plans (AHIP), the health insurance industry’s trade association, AGs affiliated with the National Association of Attorneys General describe the opioid crisis as “the preeminent public health crisis of our time.” The AGs say that while addressing addiction and recovery are crucial components in solving the problem, the issue must also be addressed further upstream—namely in the ways opioids are overused as a treatment for pain.

Full story at APTA