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Opioids are no better than over-the-counter pain relievers for treating the chronic pain of osteoarthritis, a clinical trial has found.

Researchers randomized 240 patients with moderate to severe chronic back pain or hip or knee osteoarthritis to either an opioid (morphine, oxycodone or hydrocodone) or to a nonopioid pain reliever (Tylenol or nonsteroidal anti-inflammatory drugs). The study, in JAMA, used 11-point pain and function scales to measure the effect of treatment, with higher scores indicating poorer results. This is, the authors write, the first randomized trial of opioid therapy to report long-term pain and function outcomes.

At the end of 12 months, the opioid group scored an average 3.4 on the function scale, and the nonopioid group 3.3, an insignificant difference. On the pain scale, the nonopioid group did slightly better — 3.5, compared with 4.0 for the opioid group.

Unsurprisingly, there were significantly more medication-related symptoms in the opioid group than in those who took Tylenol or NSAIDs, but there was no difference between the groups in adverse outcomes.

“Should we use opioids if nonopioids don’t work?” asked the lead author, Dr. Erin E. Krebs of the Minneapolis Veterans Affairs Health Care System. She answered her own question: “No. We tried four different nonopioids — don’t give up on them too soon — and we should also be using exercise and rehab for most osteoarthritic pain.”

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