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Comment & Response
August 7, 2018

Opioids vs Nonopioids for Chronic Back, Hip, or Knee Pain

Author Affiliations
  • 1Department of Medicine, University of Alabama School of Medicine, Birmingham
JAMA. 2018;320(5):508. doi:10.1001/jama.2018.6937

To the Editor The study by Dr Krebs and colleagues1 compared opioid with nonopioid medications for the treatment of patients with chronic back pain or hip or knee osteoarthritis pain refractory to analgesic use in veterans. We have concerns about the study’s methods and data interpretation.

The primary harms measure was a score derived from a checklist of 19 items consisting mostly of mild, common adverse events.2 This instrument captures relatively nonspecific adverse events such as sleep, mood, fatigue, headache, muscle aches, rash, incontinence, sexual problems, dizziness, and gastrointestinal symptoms. It does not capture serious adverse events commonly associated with nonopioid analgesics, such as gastrointestinal bleeding, worsening of chronic kidney disease, drug-induced liver injury, acute cardiac (eg, myocardial infarction) or neurological events (eg, stroke). These safety concerns limit nonopioid use for many patients, yet the study did not acknowledge this possibility.

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