Finally, proof: opioids are no better than other medications for some chronic pain

The linked article at the Vox website covers a major study concerning the effectiveness of opioid medications in the treatment of chronic pain. Just how useful are they? And does their usefulness justify the risks that often accompany long term opioid use?

As the article notes, there have been surprisingly few such studies, especially given the extent to which American healthcare providers have relied on opioids. For many, they remain the first, best, and sometimes the only option for chronic pain. This reliance is based on research that focused almost exclusively on shortterm measures of effectiveness– a few months at most– rather than on the longer term use so common in today’s healthcare.  And those same studies did not  compare the effectiveness of opioids with other available options, such as over the counter (OTC) pain meds like acetaminophen and ibuprofen.

Now other studies have suggested that opioids lose much of their effectiveness with prolonged use. They might even increase sensitivity to pain, in effect worsening the situation.

The study we’ve linked to examined treatment for two of the most common types of chronic pain: Back pain and arthritic pain in the hips and knees. The goal was to determine the relative effectiveness of opioid medications such as oxycodone (OxyContin)and hydrocodone (Vicodin) with other options, including their OTC counterparts. As the article states, it appears they are of equal effectiveness.

Which raises the question: Why rely so heavily on opioids when there is a cheaper, more available and relatively safer alternative? Especially in the midst of an opioid epidemic that appears to be growing worse.

Let me just speculate for a moment. One of the principal characteristics of long term opioid use is dependence. I’m not referring to addiction at the moment, but to the physiological and emotional discomfort that occurs when someone who has become severely dependent on a drug is forced to do without. Is it surprising that they experience a resurgence of pain? No. Is that pain evidence of a worsening physical condition or of drug withdrawal? Sometimes it’s difficult to tell. Perhaps impossible. That’s not something we encounter with Tylenol or physical therapy. It is common with opioids.

And we in America use more opioids than any nation anywhere in the world. How many of those are really necessary? Especially in view of the problems we’re experiencing?

It’d be worth it to find out.


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