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FOTO Rehab Outcomes Blog

Qualitative Insights: Opioids vs Non-Opioid Options for Chronic Musculoskeletal Pain

When someone is in pain, all they want is to be relieved of their pain experience.


I know from reviewing FOTO data,  that many patients present for services for musculoskeletal problems.

Mirroring influences our thoughts and perspectives of a patient. I can truly understand why opioids became so popular to prescribe. As much as the person in pain wants the pain experience to be eliminated, the healthcare provider wants to alleviate the discomfort too. In my heart, I can't believe that the over prescribing happened due to an intent to cause harm. Obviously, we now know that opioids have a high risk to do harm.

In moving forward, it is nice to see this timely article published. The beauty of the article lies in the qualitative nature of the study. The more we can learn and understand from patients themselves, the more successful we will be in forming our communication and recommendations to help them.

You'll find the abstract below.

"I was a little surprised": Qualitative Insights from Patients Enrolled in a 12-Month Trial Comparing Opioids to Non-Opioid Medications for Chronic Musculoskeletal Pain.



Chronic musculoskeletal pain is a major public health problem. 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. The Strategies for Prescribing Analgesics Comparative Effectiveness (SPACE) trial was a pragmatic 12-month randomized trial comparing benefits and harms of opioid versus non-opioid medications for chronic musculoskeletal pain. The current qualitative study was designed to better understand trial results by exploring patients' experiences, including perceptions of medications, experiences with the intervention, and whether expectations were met. Thirty-four participants who were purposefully sampled based on treatment group and intervention response participated in semi-structured interviews. The constant comparison method guided analysis. Results revealed that participants often held strong beliefs about opioid medications, which sometimes changed during the trial as they gained experience with medications; participants described a wide variety of experiences with treatment effectiveness, regardless of study group or their response to the intervention; and participants highly valued the personalized pain care model used in SPACE.


SPACE trial results indicated no advantage for opioid over non-opioid medications. Qualitative findings suggest that, for patients in both treatment groups, pre-existing expectations of medications and of anticipated improvement in pain shaped experiences with and responses to medications. In addition, the personalized pain care model was described as contributing to positive outcomes in both groups.

 2018 Apr 28. pii: S1526-5900(18)30158-5. doi: 10.1016/j.jpain.2018.04.008. [Epub ahead of print]

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