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The Journal of Pain Summary

Highlight from The Journal of Pain (Volume 19, No. 9, September 2018 Issue)

“I Was a Little Surprised”: Qualitative Insights from Patients Enrolled in a 12-Month Trial Comparing Opioids with Nonopioid Medications for Chronic Musculoskeletal Pain

Marianne S. Matthias, Melvin T. Donaldson, Agnes C. Jensen, Erin E. Krebs

The results of a 12-month randomized trial, conducted by the U.S. Department of Veterans Affairs (VA) and published in The Journal of Pain, showed that opioid therapy did not differ from nonopioid therapy when assessing pain-related function. Further, most patients in both treatment groups in the study had improved function from baseline to 12-month follow-up.

The Strategies for Prescribing Analgesics Comparative Effectiveness (SPACE) trial compared the benefits and harms of opioid versus nonopioid therapies for chronic musculoskeletal pain. For the study, 34 veterans with chronic pain were interviewed for postintervention evaluations to understand their experiences with the SPACE trial, including their views about the anticipated benefits of opioids versus nonopioid therapy. Pain treatment response was defined as improvement of at least 30% on the Brief Pain Inventory Interference Scale.

Despite the lack of evidence on the long-term effectiveness of opioids, these medications are frequently perceived to be powerful pain relievers. However, perceptions can influence patients’ responses to the medications and perhaps shape outcomes.

Study results showed opioid therapy was no more effective than nonopioid therapies for improving pain function. However, pain intensity and medication-related adverse symptom outcomes were significantly worse for opioids. Interviews also showed how patient perspectives changed over time. Some patients in the opioid group expressed disappointment in the results of their therapy, expecting greater relief than they experienced. Subjects in the nonopioid group expressed surprise that nonopioid therapy could work as well as it did.