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.
The pain relievers known as nonsteroidal anti-inflammatory drugs, or NSAIDs, are known to carry heart risks. A new analysis found that those risks can arise within a week of starting the drugs.
Researchers did a systematic review of studies involving more than 446,000 people ages 40 to 79, of whom more than 61,000 had heart attacks.
In those who used NSAIDs for one to seven days, the risk of heart attack increased 24 percent for celecoxib (Celebrex), 48 percent for ibuprofen (Advil, Motrin), 50 percent for diclofenac (Voltaren), and 53 percent for naproxen (Aleve). The increase for rofecoxib (Vioxx), which was taken off the market in 2004 because of its cardiovascular risks, was 58 percent.
The “Choosing Wisely” campaign aimed at reducing the use of unnecessary medical procedures, treatments, and tests may have received plenty of media attention since its beginnings in 2012, but new research has concluded that so far, the initiative hasn’t made a significant dent in the problem—though there are signs that it may be having an effect in some areas. Authors of a new study on the campaign see those mixed results as a call for more focused efforts to more closely link “Choosing Wisely” with actual practice.
Researchers wanted to find out if 7 specific “Choosing Wisely” recommendations, included since the list’s early days, were being used less frequently after being identified as unnecessary in most patient circumstances. To do this, they reviewed insurance claims data from 25 million members of Anthem-affiliated Blue Cross and Blue Shield programs for at least 10 quarters between 2010 and 2013 to compare usage rates pre- and post-“Choosing Wisely.”
The 7 treatments studied were: imaging tests for headache with uncomplicated conditions; cardiac imaging for members without a history of cardiac conditions; preoperative chest x-rays with unremarkable history and physical examination results; low back pain imaging for members without red flag conditions; human papillomavirus (HPV) testing for women under age 30; antibiotics for acute sinusitis; and prescription nonsteroidal anti-inflammatory drugs (NSAIDs) for members with hypertension, heart failure, or chronic kidney disease.
A recent Harvard Medical School newsletter article on nonsurgical approaches to joint pain came up short on information about the physical therapist’s (PT) role, and APTA weighed in to provide a more complete picture.
The association released a letter to the editor responding to a May 29 healthbeat newsletter article titled “4 ways to put off joint replacement.” The article listed weight loss, proper joint use, injections of steroids or other compounds, and pain reduction through NSAIDS, but made no mention of the ways in which a PT can help.