Are opioids better than nonopioids to improve pain?

President Trump's plan, unveiled on March 19, includes: cutting opioid prescription fills by one-third within 3 years, providing treatment and recovery support services for addicts, and seeking the death penalty for opioid traffickers, NPR reported.

In the midst of Trump's plan announcement, a recent study found that prescription opioids were not as effective as over-the-counter (OTC) medications for pain management.

In an appearance in New Hampshire on Monday, Trump was expected to propose that drug traffickers receive the death penalty when appropriate, along with a plan for expanded access to treatment and recovery programs and enhanced public awareness.

Meanwhile, in the large pain study, published in the March 6, 2018, issue of JAMA, pain intensity was significantly better in patients taking OTC medications such as acetaminophen versus prescription opioids such as Vicodin.

The study involved 240 Veterans Affairs' patients who had moderate to severe chronic back pain, or hip or knee osteoarthritis pain, despite analgesic use.

The researchers compared patients’ pain intensity, pain-related function, and adverse effects between opioids such as morphine, oxycodone or fentanyl patches versus non-opioids, including generic Tylenol, ibuprofen and prescription nerve and muscle pain drugs.

While the two groups—those taking prescription opioids and those taking non-opioid medications—did not significantly differ on pain-related function over a 12-month period, pain intensity was significantly better in the non-opioid group. The Brief Pain Inventory (BPI) severity was 4.0 for the opioid group and 3.5 for the non-opioid group.

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

Adverse medication-related symptoms were significantly more common in the opioid group over 12 months:1.8 in the opioid group versus 0.9 in the non-opioid group.

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