Concerns around widespread use of opioids and the accompanying problems, including rising levels of deaths from overdose, have been well publicised in the USA and UK.1,2 It is thought that long-term opioid therapy has become a standard approach to managing chronic musculoskeletal pain, despite a lack of high-quality data on benefits and harms.3 The risks associated with opioid use have highlighted a need for clinical guidance on opioid prescribing.4

A recently published study has compared the effect of opioid with non-opioid medication over 12 months on pain-related function, pain intensity and adverse effects.3 It included 240 …