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    Are non-opioid therapies more desirable than opioids for chronic pain?


    Additional findings

    The study also found:

    Pain-related interference with function did not differ between opioid and non-opioid medication arms.

    • Mean BPI-I scores at 12 months did not differ between opioid (3.4) and non-opioid (3.3) arms (P=0.584). 

    • The proportion of patients with clinically important improvement in pain-related functional interference did not differ between opioid (59.0%) and non-opioid (60.7%) arms (P=0.722).

    Pain intensity improved more in the non-opioid medication arm than in the opioid arm.

    • Mean BPI-S scores at 12 months were worse in the opioid arm (4.0) than in the non-opioid (3.5) arm (P=0.034)

    • The proportion of patients with clinically important improvement in pain intensity was lower in the opioid (41.0%) arm than in the non-opioid (53.9%) arm (P =0.007). 

    Patient-reported medication side effects were worse in the opioid arm than in the non-opioid arm. 

    • The mean number of medication-related adverse symptoms was higher in the opioid arm (1.7) than in the non-opioid (0.8) arm (P =0.040).

    Managed care executives can help by increasing access to and encouraging use of evidence-based chronic pain therapies, in addition to discouraging overuse of long-term opioid therapy, according to Krebs.

    “This study used a pharmacist care manager to deliver the effective non-opioid medication management intervention,” she says. “Improving integration of clinical pharmacists into primary care to assist with pain medication management would be an important contribution to improving clinical care.”

    Based on the study, Krebs offers the following take-aways:

    • For long-term treatment of chronic back pain and osteoarthritis pain, non-opioid medication therapy is superior to opioid therapy for both pain and side effects. 

    • This study is directly relevant to decisions about starting long-term opioid therapy. This study did not examine treatment options for patients who are already on long-term opioid therapy.

    • This study used collaborative telecare medication management by a clinical pharmacist in both treatment arms. This model of collaborative telecare medication management is effective in improving pain medication management and highly applicable to managed care settings. • A prior study published in JAMA of this model found that it doubled the rate of pain improvement compared with usual care.



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