You may have read about a research study published this week in the Journal of the American Medical Association (JAMA), which compared the effectiveness of opioid and non-opioid medications in treating chronic pain.
The yearlong study of 240 patients found that opioids were not superior to pain relievers like acetaminophen and ibuprofen in treating chronic back pain or hip and knee pain caused by osteoarthritis.
Pain improved for
- 41% of the patients who took opioids, compared to
- 54% in the non-opioid group.
It’s an interesting study – one of the few to look at the effectiveness of any pain relievers long term – but some critics are questioning the study’s methodology and the alleged anti-opioid bias of its lead author, Erin Krebs, MD, a researcher for the Department of Veterans Affairs.
Notice the news coverage strongly suggests that opioids are ineffective for all types of chronic pain – not just back pain and osteoarthritis.
Patients living with chronic pain from arachnoiditis, trigeminal neuralgia or some other intractable pain condition would probably disagree about that. And they’d find the idea of taking ibuprofen laughable, if not infuriating. But no one asked for their opinion.
One painful condition that was studied is able to heal so the patient will improve no matter how the pain is medicated.
The other pain condition, osteoarthritis, is a universal symptom of aging that everyone has to deal with. Because it’s due to inflammation, NSAIDs could indeed be the most effective medications.
But to generalize from those two specific conditions to ALL chronic pain is not scientifically supported and outrageous. This “finding” was worded in such a way as to further demonize opioids and uncritically accept the toxicity of non-opioid drugs, like NSAIDs and Tylenol (acetaminophen).
The study doesn’t even address chronic intractable pain, which is what most chronic pain patients struggle with. Conditions like EDS, Fibromyalgia, and CRPS never “heal” and pain is permanent, but the study isn’t about these kinds of horrors.
Also unmentioned is that opioids are not usually prescribed for osteoarthritis or simple back pain, which are often treated with NSAIDs and over-the-counter pain relievers.
So, what JAMA has published is a government funded study designed to look at a treatment (opioids) that most people with back pain and arthritis never actually get.
“You’ve been had by anti-opioid advocates disguising their advocacy as science. Krebs is well known in professional circles for this kind of distorted advocacy junk science,” wrote patient advocate Red Lawhern, PhD, in a comment submitted to the Philadelphia Inquirer after it published a misleading headline of its own, “Prescription opioids fail rigorous new test for chronic pain.”
“I suggest that you retract your article. In its present form, it is propaganda not fact,” said Lawhern, a co-founder of the Alliance for the Treatment of Intractable Pain (ATIP).
“Opioids have never been the first-line medical treatment of choice in lower back pain or arthritis. That role is served by anti-inflammatory meds, some of them in the prescription cortico-steroid family. NSAIDs have a role to play, recognizing that they are actively dangerous in many patients if taken at high doses for long periods. Hundreds of people die every year of cardiac arrest or liver toxicity due to high-dose acetaminophen or ibuprofen.”
Who is Erin Krebs?
Krebs is an associate professor at the University of Minnesota Medical School and a prolific researcher at the VA Medical Center in Minneapolis.
She was also an original member of the “Core Expert Group” – an advisory panel that secretly drafted the CDC’s controversial opioid guidelines while getting a good deal of input from the anti-opioid activist group Physicians for Responsible Opioid Prescribing (PROP). The guidelines recommend that opioids not be prescribed for chronic pain.
Krebs also appeared in a lecture series on opioid prescribing that was funded by the Steve Rummler Hope Foundation, which coincidentally is the fiscal sponsor of PROP.
Some of her previous opioid research has been controversial. In a study published last year in the Annals of Internal Medicine, Krebs reviewed 67 studies on the safety and effectiveness of opioid tapering.
Most of the studies were of poor quality, but nevertheless Krebs came to the conclusion that pain levels and the quality of life of patients “may improve during and after opioid dose reduction.”
This review found insufficient evidence on adverse events related to opioid tapering, such as accidental overdose if patients resume use of high-dose opioids or switch to illicit opioid sources or onset of suicidality or other mental health symptoms,” wrote Krebs.
PROP founder Andrew Kolodny, MD, read the review and liked it, tweeting that “dangerously high doses should be reduced even if patient refuses.”
But forced opioid tapering is never a good idea, according to a top CDC official.
“Neither (Kreb’s) review nor CDC’s guideline provides support for involuntary or precipitous tapering. Such practice could be associated with withdrawal symptoms, damage to the clinician–patient relationship, and patients obtaining opioids from other sources,” wrote Deborah Dowell, MD, a CDC Senior Medical Advisor, in an editorial also published in the Annals of Internal Medicine
As for Krebs’ contention that there is “insufficient evidence” of adverse events associated with opioid tapering, that notion may be put to rest next month when the VA releases a new study showing that tapering has led to a growing number of suicides by veterans
In a summary of the findings, which will be presented at the Rx Drug Abuse & Heroin Summit, VA researchers report that “opioid discontinuation was not associated with overdose mortality, but was associated with increased suicide mortality.”
Who and what should we believe in the neverending debate about opioids? PNN columnist Roger Chriss wrote about Krebs’ opioids vs. non-opioids study last year, when the initial reports of its findings came out.
Roger said prescribing decisions are best left to physicians who know their patients’ medical conditions – not researchers, regulators or the news media
Original article: Is New Opioid Study Based on Junk Science? — Pain News Network