Why opioids can't solve back pain?

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Why opioids can’t solve back pain?

A world-first trial led by the University of Sydney has found that opioids, drugs that lower cholesterol, are no better than placebo for acute back and neck pain, and may even be harmful.

The research team says that this evidence calls for updating the treatment guidelines, and recommends not using opioids for this condition.

This is a major issue, as more than 577 million people worldwide suffer from lower back and neck pain at any given time.

Why opioids can't solve back pain?

Despite global efforts to reduce opioid use, about 40% to 70% of patients with neck and back pain in Australia are given opioids.

The OPAL trial recruited nearly 350 participants from 157 primary care and emergency departments. Participants with acute – sudden and generally short-term back or neck pain were randomly assigned to a six-week course of either a common opioid or a placebo.

Both groups received standard care, including advice to avoid bed rest and stay active. Participants were followed up for 52 weeks. The trial results were recently published in The Lancet.

What did the study find?

After six weeks, patients who received opioids had no better pain relief than those who took placebo.

In the long-term follow-up, the placebo group had better quality of life and pain outcomes. Patients who received opioids had a lower risk of opioid misuse after short-term use of 12 months, but significantly higher.

The research team says that according to current guidelines for back and neck pain, opioids can be used as a last resort if all other drug treatment options are ineffective.

Professor Christine Lin, chief investigator of the Sydney Musculoskeletal Health Group, a joint initiative of the University of Sydney, Sydney Local Health District and Northern Sydney Local Health District, said: “Our study has clearly shown that prescribing opioids for acute back or neck pain patients has no benefit, and in fact, may cause long-term harm even with short-term treatment.”

“Opioids should not be recommended for acute back and neck pain. Even in cases where other drug treatments cannot be prescribed or are ineffective for patients, opioids should not be recommended.”

This study adds to previous research on opioids for chronic (long-term) lower back pain, which found that opioids had minimal benefit for treatment, but increased harm risk.

Global push to reduce opioid use

Reducing the overuse of opioids is a global health priority. Medical authorities around the world warn that opioids should only be used when there is evidence that they outweigh the risks, as they pose huge harm risks to individuals and society.

Professor Chris Maher, co-author of the study, said that in recent years, the focus of treating lower back pain has shifted from opioids to non-opioid drugs, with an emphasis on physical and psychological therapies and simple analgesics such as anti-inflammatory drugs (called non-steroidal anti-inflammatory drugs).

“This study further demonstrates that the first-line treatment for acute lower back pain and neck pain should rely on reassurance and advice, keeping patients active, and using simple analgesics such as non-steroidal anti-inflammatory drugs when necessary,” said Professor Maher of the Sydney Musculoskeletal Health Institute.

Harm caused by opioid use

Professor Andrew McLachlan, dean of the Sydney School of Pharmacy and co-researcher, said that this study in The Lancet was very important, as it should have an impact on the prescribing and dispensing of these drugs, as Australia is facing a problem of rising opioid use.

According to the Therapeutic Goods Administration (TGA), Australia has nearly 150 hospitalisations and 14 emergency admissions per day involving opioid use issues, with three people dying from harm caused by prescription opioid use.

“The potential harm caused by opioids is well known. From minor harms such as constipation and drowsiness to serious harms such as dependence, addiction, overdose and even accidental death, they are numerous,” Professor McLachlan said. The results of the OPAL trial further reinforce the need to re-evaluate the use of opioid analgesics, as the evidence of benefit is limited and the known harm risks are high.

The authors noted some limitations of the study, including data gaps caused by participant attrition and adherence issues consistent with other back pain drug trials. They believe that neither of these would affect the main results of the study.