Broad Topic Area/Title
The use of opioid and nonopioid medications in chronic pain treatment.
Problem Statement
The evidence regarding the impact of opioid treatment in comparison to nonopioid drugs for chronic pain is lacking.
Purpose Statement
To compare the pain-relieving effects of opioid and nonopioid medications for patients with hip and knee osteoarthritis as well as chronic back pain.
Research Questions
- Which type of drugs (opioid or nonopioid) reduces pain intensity more effectively?
- What adverse effects do opioid and nonopioid medications have on patients?
- Is opioid therapy necessary for patients with moderate to severe pain due to hip and knee osteoarthritis or chronic back pain?
Hypothesis
Opioids are not superior to nonopioid medications in improving pain-related function (Krebs et al., 2018).
Dependent and Independent Variables and Type of Data for the Variables
Independent: Therapeutic interventions, based on opioids and nonopioid treatment.
Dependent: Pain-related function (Brief Pain Inventory [BPI] interference scale score), pain intensity (BPI severity scale score), medication-related symptoms (score from a patient-reported checklist).
Population of Interest for Study
Adults with chronic back pain or hip/knee osteoarthritis and moderate to severe pain who did not find analgesics helpful.
Sample
240 adults with chronic pain not on long-term opioid therapy from Minneapolis primary care clinicians’ records.
Sampling Method
Purposive.
Data Collection
Demographic data were collected using phone screenings and focus chart reviews. Information about dependent variables was gathered using the BPI interference and severity scales. Finally, a patient-reported checklist checked patients’ adverse effects of medication.
Scholars contacted primary care physicians to obtain initial data sets, recruited patients, and reviewed their records. Then, all participants were randomly distributed into two groups (opioid and nonopioid). Patients were assessed during each appointment for 12 months.
Data Analysis
Include what types of statistical tests were used for the variables. Two-sided t tests and χ2 tests were utilized for comparing group outcomes at each assessment. The final analyses included logistic, Poisson, and Gaussian distribution (Krebs et al., 2018).
Results of Study
The mean age of patients was 58.3 years, 65% had back pain, and 35% – osteoarthritis pain (Krebs et al., 2018). No significant difference in pain-related function was detected between groups. Pain intensity was lower in the nonopioid group, while the opioid group had more drug-related symptoms.
Assumptions and Limitations
Opioid therapy did not have a superior effect on patients in comparison to nonopioids. All outcomes were patient-reported, potentially introducing reporting bias. Before randomization, many people preferred opioids, creating an imbalance in opinions. Patient’s characteristics were not standards, as they were recruited from veteran clinics.
Ethical Considerations
The article’s research was approved by the Minneapolis Veterans Affairs (VA) institutional review board and patients provided written informed consent (Krebs et al., 2018). Nonetheless, the study may have some ethical issues related to its intervention and data collection. First of all, it is crucial to note that the use of opioid medications may lead to addiction (Anderson & McNair, 2018). The development of an opioid use disorder is addressed by the authors who note that they monitored prescriptions and medication adherence. Moreover, the scholars asked patients to complete an Addiction Behavior Checklist during appointments, thus documenting any changes in patients’ attitude. This problem persists since all questionnaires were reliant on participants’ transparency.
The data collection process could also have been influenced by the fact that all measures were patient-based. It is possible that patients who used opioid medications reacted differently to the progression of their condition, especially if they believed that opioids were more effective than other drugs. Similarly, participants who wanted to receive opioids but were sorted into a different group could feel as though their treatment was ineffective.
Here, the information gathering process could encounter ethical problems of transparency and people’s right to choose a preferred medication approach. The publishing of the study’s results can be met with an ethical consideration about clinicians’ future recommendations to patients. If the study proved that opioids were better for treating chronic pain, it could increase the risk of opioid addiction for patients and affect treatment choices for people with chronic conditions.
References
Anderson, E., & McNair, L. (2018). Ethical issues in research involving participants with opioid use disorder. Therapeutic Innovation & Regulatory Science, 52(3), 280-284.
Krebs, E. E., Gravely, A., Nugent, S., Jensen, A. C., DeRonne, B., Goldsmith, E. S.,… Noorbaloochi, S. (2018). Effect of opioid vs nonopioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain: The SPACE randomized clinical trial. JAMA, 319(9), 872-882.