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Article by HSR&D Investigators Ranks Third Most Talked About in JAMA During 2018

January 9, 2019

Recently, JAMA announced its most popular articles of the year. Ranked by online views between September 2017 and August 2018, JAMA then interviewed journal editors to find out why the high-ranking articles were so popular with physicians and, oftentimes, the public. The article titled Effect of opioid vs. non-opioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain: the SPACE randomized clinical trial by HSR&D investigator Erin Krebs, MD, MPH, and colleagues was the third most talked about article published by JAMA in 2018. This HSR&D-funded study found that opioids do not result in better pain-related function or pain intensity compared to non-opioid drugs in Veterans with chronic pain.

Investigators compared opioid therapy versus non-opioid medication therapy over 12 months for VA primary care patients with chronic back pain or hip or knee osteoarthritis pain. Investigators identified 240 Veterans with chronic pain that was moderate-to-severe despite analgesic use. Veterans were recruited from 62 Minneapolis VA primary care clinicians from June 2013 to December 2015. Patients were then randomly assigned to one of two intervention groups: opioid therapy or non-opioid medication therapy (acetaminophen or a non-steroidal anti-inflammatory drug). The primary outcome was pain-related function over 12 months, and the main secondary outcome was pain intensity. Overall, findings showed that opioids did not demonstrate any advantage over non-opioid medications that could potentially outweigh their greater risk of overdose and other serious harms.

Findings from this research also were discussed in the Washington Post (“Prescription opioids fail rigorous new test for chronic pain”), in which UCLA’s Geriatrics Chief Dr. David Reuben stated, “This is a very important study. It will likely change the approach to managing long-term back, hip and knee pain.” NPR also highlighted the study in their article “Opioids don’t beat other medications for chronic pain.”

Dr. Krebs is part of HSR&D’s Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis, MN.

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