Opioid Deprescribing
There is clear evidence that opioids are not effective for long term chronic non-cancer pain. In fact, patients are worse of in terms of pain levels with opioid use. Furthermore opioid use has real harm.[1]
A landmark study was published in 2018 by Krebs et al - the SPACE study. It was a pragmatic randomised controlled trial comparing opioid versus non opioid analgesics for 1 year in primary care. Participants were 240 VA patients with moderate to severe chronic back pain or knee/hip OA, and not on opioids. The mean pain intensity initially was 5.4 in both arms. Pain scores at 1 year was worse in the opioid arm (4.0) than non opioid (3.5) (P=0.034). There was no difference in pain interference, and adverse effects were worse in opioid group (P=0.03).[1]
