Study: Opioids no more effective than other pain medications

In a new study published Tuesday in the journal JAMA, researchers found patients taking opioid painkillers managed their pain no better than patients taking safer, alternative pain medications.

The study, Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain, is the first randomized clinical trial to make a head-to-head comparison between opioids and other forms of pain medications.

The researchers studied 240 patients from Veterans Affairs primary care clinics with moderate to severe chronic back pain, or hip or knee osteoarthritis pain despite taking analgesics. The participants' average age was 58. After a 12-month period, researchers found the use of opioids versus non opioid medications did not result in significantly improved pain-related function.

"Treatment with opioids was not superior to treatment with non opioid 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 study stated.

Here's what opioids do to your health:

12 PHOTOS
What opioids do to your health
See Gallery
What opioids do to your health

Opioid painkillers capitalize on our body's natural pain-relief system. We all have a series of naturally produced keys ("ligands") and keyholes ("receptors") that fit together to switch on our brain's natural reward system — it's the reason we feel good when we eat a good meal or have sex, for example. But opioids mimic the natural keys in our brain — yes, we all have natural opioids! When they click in, we can feel an overwhelming sense of euphoria.

Photo credit: Getty 

Opioid painkillers can have effects similar to heroin and morphine, especially when taken in ways other than prescribed by a doctor.

When prescription painkillers act on our brain's pleasure and reward centers, they can make us feel good. More importantly, though, they can work to reinforce behavior, which in some people can trigger a repeated desire to use.

Photo credit: Getty 

You may also feel sleepy.

Opioids act on multiple brain regions, but when they go to work in the locus ceruleus, a brain region involved in alertness, they can make us sleepy. Why? The drugs essentially put the brakes on the production of a chemical called norepinephrine, which plays a role in arousal.

Photo credit: Getty 

Your skin may feel flushed and warm.

Photo credit: Getty 

You'll begin to feel their effects 10 to 90 minutes after use, depending on whether they're taken as directed or used in more dangerous ways.

Some drugmakers design versions of their medications to deter abuse. Extended-release forms of oxycodone, for example, are designed to release slowly when taken as directed. But crushing, snorting, or injecting the drugs can hasten their effects.

It can also be deadly. Between 2000 and 2014, nearly half a million Americans died from overdoses involving opioid painkillers and heroin, a report from the US Centers for Disease Control and Prevention found. The most commonly prescribed painkillers were involved in more overdose deaths than any other type of the drug.

Photo credit: Getty 

Your breathing will slow as well.

Photo credit: Getty 

Depending on the method used, the effect can last anywhere from four to 12 hours.

For severe pain, doctors typically prescribe opioid painkillers like morphine for a period of four to 12 hours, according to the Mayo Clinic. Because of their risks, it's important to take prescription painkillers only according to your physician's specific instructions.

Photo Credit: Getty 

Overdosing can stop breathing and cause brain damage, coma, or even death.

A 2014 report from the American Academy of Neurology estimates that more than 100,000 Americans have died from prescribed opioids since the late 1990s. Those at highest risk include people between 35 and 54, the report found, and deaths for this age group have exceeded deaths from firearms and car crashes.

Photo Credit: Getty 

Combining them with alcohol or other drugs — even when taken according to the directions — can be especially deadly.

Since they slow breathing, combining opioid painkillers with other drugs with similar effects can drastically raise the chances of accidental overdose and death.

Yet they're often prescribed together anyway, according to the National Institute on Drug Abuse. "Unfortunately, too many patients are still co-prescribed opioid pain relievers and benzodiazepines [tranquilizers]," the institute said. In 2011, 31% of prescription opioid-related overdose deaths involved these drugs.

Photo credit: Getty 

Abusing opioid painkillers has been linked with abusing similar drugs, like heroin.

A CDC report found that people who'd abused opioid painkillers were 40 times as likely to abuse heroin compared with people who'd never abused them. The National Institute on Drug Abuse says that close to half of young people surveyed in three recent studies who'd injected heroin said they'd abused prescription painkillers before they started using heroin.

Photo credit: Getty 

You may also develop a tolerance for the drugs so that you need more to get the same effect over time.

Tolerance to opioid painkillers happens when the brain cells with opioid receptors — the keyholes where the opioids fit — become less responsive to the opioid stimulation over time. Scientists think that this may play a powerful role in addiction.

Photo credit: Getty 

Suddenly stopping the drugs can result in withdrawal symptoms like shakiness, vomiting, and diarrhea.

Taking prescription painkillers for an extended period increases the likelihood that your brain will adapt to them by making less of its own natural opioids. So when you stop taking the drugs, you can feel pretty miserable. For most people, this is uncomfortable but temporary.

But in people who are vulnerable to addiction, it can be dangerous because it can spurn repeated use.

"From a clinical standpoint, opioid withdrawal is one of the most powerful factors driving opioid dependence and addictive behaviors," Yale psychiatrists Thomas Kosten and Tony George write in a 2002 paper in the Journal of Addiction Science & Clinical Practice.

Photo credit: Getty 

HIDE CAPTION
SHOW CAPTION
of
SEE ALL
BACK TO SLIDE

In fact, researchers found participants taking non opioid painkillers, such as Tylenol, ibuprofen and lidocaine, experienced less pain intensity than those taking opioid drugs, such as morphine, Vicodin and oxycodone. Additionally, patients taking opioid painkillers were more likely to experience negative side effects than those taking non opioid painkillers, according to the study.

"Overall, opioids did not demonstrate any advantage over non opioid medications that could potentially outweigh their greater risk of harms," wrote the researchers, led by Dr. Erin Krebs of the Minneapolis Veterans Affairs Health Care System's Center for Chronic Disease Outcomes Research.

Krebs and her team said the driving force behind their research is the country's escalating opioid epidemic and related overdose deaths, the Los Angeles Times Reported, which according to the Centers for Disease Control and Prevention, claims 115 American lives per day.

Copyright 2017 U.S. News & World Report

Read Full Story