Effect of opioid vs nonopioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain: The SPACE randomized clinical trial

Krebs EE, Gravely A, Nugent S, et al. JAMA. 2018 Mar 6;319(9):872-82. [CrossRef] [PubMed]

Opioids are usually considered more efficacious than nonopioids for acute pain. Based on this, opioids have been assumed to be better pain relievers than nonopioids for chronic pain. The authors challenged that assumption in 240 patients with moderate to severe chronic back pain or hip or knee osteoarthritis. Patients were randomized to either opioids (immediate-release morphine, oxycodone, or hydrocodone/acetaminophen) or non-opioids (acetaminophen or a nonsteroidal anti-inflammatory). Medications were changed, added, or adjusted within the assigned treatment group according to individual patient response. The primary outcome was pain-related function (Brief Pain Inventory [BPI] interference scale) over 12 months and the main secondary outcome was pain intensity (BPI severity scale). Groups did not significantly differ on pain-related function over but pain intensity was significantly better in the nonopioid group. These results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain.