Treatment with opioids was not superior to treatment with nonopioid medications for improving pain-related function over 12 months in patients with chronic back pain or hip or knee osteoarthritis pain, a recent study found. The randomized clinical trial included 240 patients from primary care clinics from June 2013 through December 2015 with follow-up completed December 2016.

Both interventions (opioid and nonopioid medication therapy) followed a treat-to-target strategy aiming for improved pain and function. Each intervention had its own prescribing strategy that included multiple medication options in 3 steps. In the opioid group, the first step was immediate-release morphine, oxycodone, or hydrocodone/acetaminophen. For the nonopioid group, the first step was acetaminophen (paracetamol) or a nonsteroidal anti-inflammatory drug. The primary outcome was pain-related function over 12 months and the main secondary outcomes was pain intensity. Researchers found:

• Groups did not significantly differ on pain-related function over 12 months.
• Pain intensity was significantly better in the nonopioid group over 12 months.
• Adverse medication-related symptoms were significantly more common in the opioid group over 12 months.