What the JAMA Opioid Study Didn’t Find — Pain News Network – March 10, 2018 – By Roger Chriss, Columnist
A recent opioid study published in the Journal Of the American Medical Association (JAMA) evaluated pain management in patients with hip and knee osteoarthritis and low back pain
The study by VA researcher Erin Krebs, MD, and colleagues found that “treatment with opioids was not superior to treatment with nonopioid medications for improving pain-related function over 12 months.”
Pain patients know this is simply untrue – at least for those of us who suffer from serious, daily, intractable pain.
That finding was widely and erroneously reported in the news media as meaning that opioids are ineffective for all types of chronic pain.
But the most fascinating result of the study – the one not being reported — is what wasn’t found.
I also wrote about this earlier in “Krebs Study” Shows Opioids are Safe.
The 108 people in the study who took opioids for a year
- did not develop signs of opioid misuse, abuse or addiction, and
- did not develop opioid-induced hyperalgesia – a heightened sensitivity to pain.
Krebs and colleagues closely monitored the 108 people in the opioid arm of the study, using “multiple approaches to evaluate for potential misuse, including medical record surveillance for evidence of ‘doctor-shopping’ (seeking medication from multiple physicians), diversion, substance use disorder, or death.”
They also had participants complete the “Addiction Behavior Checklist” and assessed their alcohol and drug use with surveys and screening tools.
What did Krebs find in the opioid group after 12 months of treatment?
“No deaths, ‘doctor-shopping,’ diversion, or opioid use disorder diagnoses were detected,” she reported. “There were no significant differences in adverse outcomes or potential misuse measures.”
These are observational findings in the study. They were not a part of what Krebs and colleagues were specifically trying to measure.
As the study notes: “This trial did not have sufficient statistical power to estimate rates of death, opioid use disorder, or other serious harms associated with prescribed opioids.”
But they are valuable observations. They note what didn’t happen in the study.
Over 100 people were put on opioid therapy for a year, and none of them showed any signs of dose escalation or opioid-induced hyperalgesia, or any evidence of opioid misuse, abuse or addiction.
In other words, Krebs and colleagues used an opioid prescribing protocol that achieved an admirable level of patient safety.
Their approach is similar to what many pain management practices currently pursue and what the CDC and various state guidelines recommend: Risk assessment before initial prescribing and careful monitoring over time.
The Krebs study provides rare and detailed observations of what happens when people are put on long-term opioid therapy.
A lot of what is claimed about dose escalation, opioid-induced hyperalgesia, and misuse or abuse didn’t happen at all.
This outcome demonstrates that long-term opioid therapy can be safe and effective, and may be useful in treating other chronic conditions, from intractable neuropathies to painful genetic disorders. That’s worth reporting, isn’t it?
Author: Roger Chriss lives with Ehlers Danlos syndrome and is a proud memberof the Ehlers-Danlos Society. Roger is a technical consultant in Washington state, where he specializes in mathematics and research.