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Patients receiving non-opioids ‘surprised’ by effectiveness

Many patients who received non-opioids were surprised by how well they relieved pain, according to data published in the Journal of Pain.

“Chronic musculoskeletal pain is a major public health problem,” Marianne S. Matthias, PhD, from Regenstrief Institute, Indianapolis, and colleagues wrote. “Although opioid prescribing for chronic pain has increased dramatically since the 1990s, this practice has come under scrutiny because of increases in opioid-related harms and lack of evidence for long-term effectiveness.”

Many patients believe that opioids are “strong, powerful pain relievers” and this perception may affect their response to medications and potentially shape outcomes, according to Matthias and colleagues.

The researchers conducted semi-structured interviews with 34 adult patients with chronic musculoskeletal pain from the Strategies for Prescribing Analgesics Comparative Effectiveness trial to assess their perceptions of opioid and non-opioid medications, how their perceptions affect their experiences with these medications and whether their expectations were met.

Many patients who received non-opioids were surprised by how well they relieved pain.

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Patients were randomly assigned to the opioid (n = 18) or non-opioid (n = 16) intervention group. A study pharmacist worked with most patients in the opioid group after the end of the intervention to help them transition to non-opioid medication.

Many patients preferred to be in the opioid group because they believed that opioids were stronger. Others were concerned about being in the opioid group due to fears of addiction and impairment. Negative perceptions of opioids were often shaped by past personal experiences or those of friends or family, according to the researchers.

Some patients in the non-opioid group expressed that non-opioids relieved pain better than expected. Conversely, some patients in the opioid group expressed disappointment with the effects of opioids and said that they expected them to provide greater relief and that effectiveness dwindled with time.

Patients in both groups reported that they valued personalized medication management with a clinical pharmacist to meet their physical and emotional needs.

Function was improved with both treatments. The researchers found that over time, patients’ perspectives changed as they used the medications.

“The role of expectations played a prominent role in patients’ experiences... In addition to the role of expectation, patients expressed a high degree of satisfaction with the personalized pharmacist care model that patients in both study arms experienced,” Matthias and colleagues concluded. “The presence of a caring, responsive clinician seeking to improve patients’ pain may in part help to explain why, although opioids showed no advantage over non-opioids, patients in both study arms improved.” – by Alaina Tedesco

Disclosure: The authors report no relevant financial disclosures.