Over-The-Counter Painkillers More Effective than Opioids?
Over-The-Counter Painkillers More Effective than Opioids?

Opioids are extremely powerful drugs typically prescribed by doctors to patients to treat moderate to severe pain. The most common opioids prescribed to individuals include oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, and many others. In recent years, there has been an increase in prescribing and using the drugs under the belief that common over-the-counter painkillers, such as acetaminophen, aren’t as effective when it comes to treating chronic pain.

However, a new study sponsored by the Veterans Affairs (VA) Office of Research and Development suggests that opioids may not be as significantly more effective as they were commonly billed.

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The Study - Opioids and Over-the-Counter Painkillers

Dr. Erin Krebs and her team of researchers at the Minneapolis Veterans Affairs Health Care System recruited 240 patients with hip arthritis, knee arthritis, or chronic back pain from Veterans Affairs primary care clinics for the Strategies for Prescribing Analgesics Comparative Effectiveness (SPACE) Trial. Patients were then randomly assigned to one of two protocols:

  • Opioid-intensive -- emphasizes early use of strong opioid analgesics.
  • Opioid-avoidant -- emphasizes non-opioid medications from several drug classes.

Each group had its own unique prescribing strategy that included several medication options in three steps. For example, the first step in the opioid group was immediate-release morphine, oxycodone, or hydrocodone/acetaminophen, while the first step in the non-opioid group was acetaminophen or another nonsteroidal anti-inflammatory drug. Medications were adjusted during the course of the trial according to each patient’s preferences and responses.

Following a year of treatment, approximately 60% of the patients in each group experienced significant improvements in their ability to perform daily functions without interference from pain. However, pain intensity improved significantly in only 41% of the patients receiving opioids compared to 54% of those receiving non-opioid treatments.

To further compound the issue, Dr. Krebs and her team noted that patients taking opioids experienced twice as many side effects as the group using non-opioid medications.

Based on these findings, researchers concluded that the:

“Results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain.” [1]

Another Blow to Big Pharma

The results of the study came as another blow to opioid manufacturers, many of whom are currently facing hundreds of lawsuits filed by numerous cities in the United States for their role in the increasing opioid crisis. As it currently stands, over 300 lawsuits are on hold as the pharmaceutical companies are embattled in settlement talks as ordered by a federal judge in Cleveland.

Do the results of the study come as a surprise to you?

Have you ever been prescribed opioids for treating intense pain, and did find them any more effective than over-the-counter painkillers like Tylenol or Aleve?

Leave us a comment with your thoughts.

1) Krebs EE, Gravely A, Nugent S, Jensen AC, DeRonne B, Goldsmith ES, Kroenke K, Bair MJ, Noorbaloochi S. 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. JAMA. 2018;319(9):872–882. doi:10.1001/jama.2018.0899