For Arthritis Pain, Tylenol Works as Well as Opioids

Getty Images  John Moore

Getty Images John Moore

The opioid group was prescribed morphine, oxycodone, or hydrocodone, while the non-opioid group was prescribed acetaminophen (i.e., Tylenol) or a nonsteroidal anti-inflammatory drug (i.e., Advil). While there are many conditions that can cause chronic pain, like autoimmune diseases, Ehlers-Danlos syndrome and fibromyalgia, only back pain and hip or knee pain from osteoarthritis were included in the study.

When Dr. Erin Krebs was in medical school in the '90s, she was taught to avoid prescribing opioids long-term because the drugs were addictive.

Opioid medications were not better than nonopioid treatment to improve chronic back, hip or knee pain, according to medical research conducted at Veterans Affairs clinics in Minnesota.

"Overall, opioids did not demonstrate any advantage over non opioid medications that could potentially outweigh their greater risk of harms", the researchers wrote.

About 42,000 drug overdose deaths in the United States in 2016 involved opioids, including prescription painkillers, heroin and fentanyl.

"Treatment with opioids was not superior to treatment with nonopioid medications for improving pain-related function over 12 months", the authors wrote in the conclusion.

Except this wasn't the case: although patients were expecting opioids to be more effective, they weren't. The participants were then asked to rate their pain every three months, on two scales: intensity and functionality (how easy it is to go about your day-to-day life). Patients were randomly assigned to an opioid or non-opioid group (participants knew which group they were in and what medications they were taking). The mean patient age was 58.3 years old and 13 percent of participants were women.

False news spreads widely and easily
From that link, the researchers backtracked through the retweet chain, which they called a cascade, to find the rumor's origin. Vosoughi remains skeptical, though, and said that he thinks these interventions will influence only a small number of people.

After a year of pain treatment, the researchers saw no evidence that opioids were better than the alternatives.

"This study does not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain".

The results likely will surprise many people "because opioids have this reputation as being really powerful painkillers, and that is not what we found", Krebs said. This was measured with a patient reported checklist.

The group that took opioids didn't do particularly well in either category-in fact, the group that wasn't on opioids reported less pain; the group scored, on average, a half-point lower on a "pain intensity" scale ranging from one to 10.

Patients in the opioid group had significantly more trouble with medication-related symptoms.

These patients explained what people should keep in mind about chronic pain when reading the study.

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