Did someone say aspirin works better than opioids?

Jonathan Kaupanger
July 02, 2018 - 4:24 pm

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Opioids are a National mess.  But now there’s proof that veterans suffering chronic pain can get the same relief from non-opioids.  In fact, the end result from non-opioids are even better than that of the stronger drugs!

“We think of them as being very strong medications,” said Dr. Erin E. Krebs regarding opioids.  Krebs is a Health Services Researcher & Primary Care Doctor at the Minnesota VA Medical Center & Associate Professor of Medicine at the University of Minnesota.  “And certainly when we’re using them in a hospital setting, high dose, short term, carefully monitored, they are great for that really severe pain.  But over the long term for people with back pain and arthritis, they just don’t work better than the other options. 

Dr. Krebs recently finished a yearlong VA Research funded trial to see if opioids were the best drugs to use for pain.  Specifically life-interfering lower back pain and hip or knee arthritis pain.   The study had two groups, one on opioids, the other wasn’t.  They measured outcomes in three different ways: How much does the pain interfere with life activities?  How severe is the pain itself?  What were the side effects?

There was no difference between the two groups with the first measurement.  For numbers two and three though, it was very different, but not what you would think.  On pain intensity, the non-opioid group actually did better.  There was more improvement in dealing with the pain.  And on side effects, the people who took opioids had far more side effects – twice as many actually – than the non-opioid group.

“I think what this new finding tells us is that we can actually not make pain control worse,” said Krebs.  “Backing away from opioids doesn’t mean that we aren’t going to be able to manage pain.  Opioids weren’t that great for pain anyway.  And even if they work for the pain, most people actually feel worse over time.  All the side effects!  It’s actually really sad, and even worse to think that they’re not actually going to improve the pain over the other options.”

This is not suggesting that aspirin is as good as opioids.  The reason the non-opioid group worked is reassessment and readjustment.  The non-opioid group in the study had a pharmacist on hand who would call the patients and if something wasn’t working would stop it and try something new.  “It wasn’t just here’s some Tylenol or here’s some morphine,” explains Krebs.  “We were really working with people to find medicine that would work for them.  What we found is when you’re paying attention like that and trying different things, we can find medications that work as well or better as opioids for people.”

If you’re not already taking opioids, veterans who are currently experiencing pain should ask their primary care physician about these other options.  Dr. Krebs says that some of the most effective treatments for pain are the old fashioned things that aren’t used as often anymore, like exercise and manual therapies.

If you are already on an opioid prescription, Dr. Krebs has three questions you can ask your doctor right now.  Can I try backing off these and see what happens?  Are they really doing me much good?  Could I be doing just as well on a lower dose or off the medication?  Research shows that most people who reduce their doses, carefully and gradually with help will improve pain relief. 

All VA facilities have someone on staff who can help you find the best method to manage your pain.  You can start your pain free search online with VA’s Pain Management 101.  You can explore some of VA’s Complementary Treatments that are designed to work in conjunction with other medical care to help relieve pain.

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