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Comment & Response
August 7, 2018

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

Author Affiliations
  • 1Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota
JAMA. 2018;320(5):508-509. doi:10.1001/jama.2018.6953

In Reply Drs Wang and Macaulay seek details about SPACE eligibility and nonpharmacological therapies. Patients were screened in 3 stages—automated diagnosis search, structured telephone interview, physician chart review—and enrolled only if documentation from prior evaluations supported the qualifying diagnosis at the reported pain location.1 They suggest patients may not have received “sufficient” preenrollment nonopioid therapy. Consistent with our objective to compare medication approaches, eligibility criteria required failure of prior medications, but not nonpharmacological therapies. Prestudy treatments included spine injections (28%) or surgery (20%) and knee or hip injections (45%) or surgery (34%). Nonpharmacological therapies during SPACE were presented in eTable 10 in Supplement 2.