Opioids vs Over-The-Counter Meds: Which Works Best For Chronic Pain Relief?

By Kelly Burch 03/09/18

The results of a new study may lead healthcare providers to reconsider whether opioid treatment is appropriate for people with chronic pain.

Prescription vs. Over the Counter

Despite being marketed as the gold standard of pain relief and patient care, a new study shows that opioid painkillers are no more effective than Tylenol and other over-the-counter pain relief meds for alleviating moderate to severe chronic pain. 

The study, published in the Journal of the American Medical Association, followed 240 adults with moderate to severe back pain or hip or knee pain caused by osteoarthritis. The patients were randomly assigned to be treated with opioid painkillers or with non-opioid options, including over-the-counter pain relievers and non-opioid prescription drugs. 

After 12 months, the researchers found that people in the non-opioid group actually experienced less pain, and far fewer side effects than patients who were on opioids. 

“Treatment with opioids was not superior to treatment with non-opioid medications for improving pain-related function over 12 months,” the study's authors wrote. “Results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain.”

Dr. Erin Krebs, who works with the Minneapolis Veteran's Administration Health Care System and the University of Minnesota, led the study. She said that previous work had compared opioid effectiveness against placebos, but none had compared opioids to non-opioid pain relief options. 

"The studies that we had out there were short-term studies and mostly compared opioids to placebo medications," she told NPR. "From those studies, we knew that opioids can improve pain a little bit more than a placebo, or sugar pill, in the short term, but that's all we knew.”

The results were surprising. 

"There was really no difference between the groups in terms of pain interference with activities,” Krebs explained. “And over time, the nonopioid group had less pain intensity and the opioid group had more side effects.” 

Importantly, patients in the study knew which group they were being assigned to. Researchers set up the study that way because patient expectations can affect how they experience pain relief. The more strongly a patient believes that a pill will provide relief, the more likely it is to work. 

"We found at the beginning of the study that patients who were enrolled really thought that opioids were far more effective than nonopioid medications,” Krebs said. Despite that, the patients in the opioid group reported less favorable outcomes over the course of the year. 

Krebs theorizes that opioid tolerance is why patients on the more powerful drugs did not experience long-term pain relief. 

"Within a few weeks or months of taking an opioid on a daily basis, your body gets used to that level of opioid, and you need more and more to get the same level of effect,” she said. 

Overall, she believes the study should encourage healthcare providers to reconsider whether opioid treatment is appropriate for people with chronic pain. This is significant since chronic pain patients have been sharply critical of tightening restrictions on opioids, which they say increase their quality of life. 

"This study adds the long-term evidence that shows that opioids really don't have any advantages in terms of pain relief that might outweigh the known harms that they cause," Krebs said.

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Kelly Burch writes about addiction and mental health issues, particularly as they affect families. Follow her on TwitterFacebook, and LinkedIn.