In some situations, the answer may be neither. In a recent randomized clinical trial of 240 patients with moderate to severe chronic back pain or hip or knee osteoarthritis despite analgesic use, the researchers found no significantly better pain-related function when patients received opioid versus non-opioid medication.
In the opioid group, patients were started on immediate-release morphine, oxycodone, or hydrocodone/acetaminophen. The non-opioid group of patients started with acetaminophen (paracetamol) or a nonsteroidal anti-inflammatory drug. In both groups, medications were added or adjusted based on individual patient response. Over 12 months, the groups did not significantly differ on pain-related function.