Here’s What You Need to Know Before You Take Opioids for Lower and Back Pain
Scientists have found a big problem with using opioid painkillers to treat lower and back pain – and it’s not about the opioid overdose epidemic.
A groundbreaking trial conducted by the University of Sydney has revealed that opioid pain-relieving medications are not superior to placebos in alleviating acute back and neck pain. In fact, these medicines may even lead to harm.
The findings of this world-first study provide compelling evidence for the revision of treatment guidelines, recommending against the use of opioids for this specific purpose.
It is estimated that approximately 577 million people worldwide experience low back and neck pain at any given time. Despite global efforts to minimize opioid usage, statistics indicate that in Australia, opioids are prescribed to around 40 to 70 percent of individuals seeking relief from neck and back complaints.
The OPAL trial enrolled nearly 350 participants from 157 primary care and emergency department facilities. These participants, who were suffering from sudden and generally short-term back or neck pain, were randomly assigned to receive a six-week course of a commonly prescribed opioid or a placebo. Both groups also received standard care, which involved guidance to avoid bed rest and maintain an active lifestyle. The participants were then monitored for a duration of 52 weeks.
The results of the trial, published in The Lancet, unveiled several important findings. Firstly, at the six-week mark, individuals who received opioids did not experience superior pain relief compared to those given the placebo. Moreover, when evaluating long-term follow-up assessments of the quality of life and pain outcomes, the placebo group exhibited better results. Alarmingly, patients who received opioids faced a slightly elevated but statistically significant risk of opioid misuse twelve months after completing their short course of medication.
The current guidelines for back and neck pain suggest that opioids should be considered as a last resort when all other pharmacological alternatives have been exhausted. However, the research team behind this study asserts that the findings provide compelling evidence to challenge this viewpoint. In light of the study’s results, they argue that opioids should not be recommended at all for the treatment of back and neck pain.
“We have clearly shown there is no benefit to prescribing an opioid for pain management in people with acute back or neck pain, and in fact, it could cause harm in the long-term even with only a short course of treatment,” commented lead investigator Professor Christine Lin.
“Opioids should not be recommended for acute back and neck pain full stop.
“Not even when other drug treatments are not able to be prescribed or have not been effective for a patient.”
The study builds upon previous research examining the use of opioids for chronic low back pain, which demonstrated a slight therapeutic advantage but also highlighted an elevated risk of harm associated with their usage.
Reducing the excessive utilization of opioids is a paramount objective in global healthcare. Medical authorities worldwide have cautioned that opioids should only be employed when the benefits are proven to outweigh the potential harms, due to the significant risks they pose to individuals and society.
Co-author Professor Chris Maher highlights a recent shift in focus towards non-opioid treatments, physical and psychological therapies, and the use of simple analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs) for managing low back pain.
“This study is further evidence that the first line management of acute low back pain and neck pain should rely on reassurance and advice to stay active, and simple analgesics like non-steroidal anti-inflammatory drugs if necessary,” added Professor Maher, also of Sydney Musculoskeletal Health.
Harm associated with opioid usage
Professor Andrew McLachlan, Dean of Sydney Pharmacy School and co-investigator of the study, highlights the significance of the Lancet publication and its potential impact on prescribing and dispensing practices, particularly as Australia faces escalating rates of opioid use.
According to Australia’s Therapeutic Goods Administration, opioid-related issues result in nearly 150 hospitalizations and 14 emergency department admissions daily in the country, leading to three deaths due to prescription opioid-associated harm.
The well-known harmful effects of opioids range from minor issues such as constipation and drowsiness to severe consequences like dependence, addiction, overdose, and unintentional fatalities, as stated by Professor McLachlan.
The findings from the OPAL trial further reinforce the necessity to reassess the utilization of opioid pain-relieving medications, as their benefits are limited while the risks of significant harm are well-established.
The authors acknowledge certain limitations of the study, including data gaps resulting from participant attrition and challenges with medication adherence, which are consistent with other trials involving back pain medications. However, they posit that neither of these factors is likely to have influenced the primary outcomes of the study. While these limitations are recognized, they are not believed to have significantly impacted the overall findings and conclusions of the research.
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