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Comment & Response
August 7, 2018

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

Author Affiliations
  • 1Baylor Institute for Rehabilitation, Dallas, Texas
  • 2New York University Langone Medical Center, New York
JAMA. 2018;320(5):506-507. doi:10.1001/jama.2018.6945

To the Editor Dr Krebs and colleagues1 compared opioid with nonopioid medications in improving pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain. We have several concerns about the study design and generalizability of the results.

First, potentially eligible patients were identified by searching the electronic health record for back, hip, or knee pain diagnoses at a primary care visit. It is not clear that the patients with knee or hip pain were truly painful due to osteoarthritis. Osteoarthritic radiographic changes are common, but these radiographic manifestations of osteoarthritis often are not the cause of the pain described by the patient. Many other conditions can cause knee and hip pain. It would be helpful if more detailed description of inclusion criteria was given.

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