When asked about the study’s limitations,
Dr. Joel Frank, a licensed psychologist at Duality Psychological Services in California,
not involved in the study, told
MNT: “Firstly, the treatment protocol was medication-focused, but 42%
of the sample was non-compliant. Secondly, their ‘guideline care’
included physical activity recommendations, but they stated the care was
“Thirdly, their primary measure for pain severity was the BPI, a
self-report measure,” said Dr Frank. “Self-report measures
are inherently subjective. When utilizing self-report measures for pain,
it is advisable to include additional measures that evaluate pain catastrophization
to derive a fuller picture of the subjective experienced pain level.”
MNT also spoke with
Dr. Vernon Williams, a sports neurologist, pain management specialist, and founding director
of the Center for Sports Neurology and Pain Medicine at Cedars-Sinai Kerlan-Jobe
Institute in California, not involved in the study.
Dr. Williams noted that the results are limited as rather than comparing
opioid use to no treatment, they compared it to a placebo, which is capable
of inducing a physical response.
“There are physiologic effects related to your body responding to
the expectation of the active treatment and your body’s response
to the potential benefit — or expectation — of the placebo.
So rather than the opioid not being effective, the study showed that the
opioid did not outperform [the] placebo. It’s a subtle, but significant
distinction,” he noted.
MNT also asked
Dr. Gustavo De Carvalho Machado, senior research fellow at the University of Sydney, Australia, not involved
in the study, about its limitations. He cautioned that:
“The findings are not directly applicable to pre-hospital —
patients who require an ambulance — and emergency department settings.
Patients who present to these settings have more severe pain and disability
and the outcomes of this trial were measured weeks after recruitment and
in emergency settings timely analgesia within hours is crucial for management
and discharge planning.”