Opioids are one of the most prescribed painkillers for people with back and neck pain.In Australia, around 40% of people I visited my family doctor with low back and neck pain. 70% of people Opioids such as oxycodone are prescribed to people who visit a hospital emergency department with back pain.
But our new researchpublished in July. lancet A medical journal found that opioids do not relieve “acute” back and neck pain (which lasts up to 12 weeks) and may make the pain worse.
Our findings show that opioids should do not have Recommended for acute lower back pain and neck pain. Prescription changes for low back and neck pain are urgently needed. Australia and World wide To reduce opioid-related harm.
Comparison of opioids and placebo
In our trial, we randomly assigned 347 people with acute low back and neck pain to receive either opioids (oxycodone and naloxone) or naloxone. placebo (Tablets that look the same but do not contain the active ingredient).
Oxycodone is an opioid analgesic that can be taken orally. naloxoneThis drug, an opioid antagonist, reduces the severity of constipation without interfering with the analgesic effects of oxycodone.
Participants took opioids or a placebo for up to six weeks.
People in both groups also received education and advice From your doctor. This could, for example, be advice about returning to normal activities and avoiding bed rest.
We evaluated their performance over a one-year period.
What did we find?
After 6 weeks of treatment, taking opioids did not improve pain relief compared to placebo.
There were also no benefits in other outcomes such as physical function, quality of life, recovery time, or absenteeism.
More people in the opioid-treated group experienced nausea, constipation, and dizziness than the placebo group.
The one-year results highlight the potential long-term harms of opioids, even with short-term use. Compared to the placebo group, people in the opioid group experienced slightly more pain and reported a higher risk of: Opioid misuse (Thinking, mood, behavioral problems, or opioid use that differs from how the drug is prescribed).
More people in the opioid group reported pain after one year: 66 people compared with 50 in the placebo group.
What does this mean for opioid prescribing?
In recent years, international guidelines for low back pain have shifted the focus of treatment from drug therapy to non-drug therapy. evidence There are concerns about limited therapeutic efficacy and harms associated with drug therapy.
In case of acute low back pain, guidelines Recommend patient education and advice and recommend the use of anti-inflammatory analgesics such as ibuprofen if necessary.Opioids are Recommended only If other treatments have not worked or are not appropriate.
guidelines neck Pain similarly precludes opioid use.
Our latest research clearly shows that for people with acute low back and neck pain, the benefits of opioids do not outweigh the possible harms.
Rather than recommending the use of opioids for these conditions in certain circumstances, patients should refrain from using opioids without qualification.
Changes are possible
Complex problems such as opioid use require smart solutions, and another study we conducted recently provides compelling data that opioid prescribing can be successfully reduced. .
of study The study involved four hospital emergency departments, 269 clinicians, and 4,625 low back pain patients. The intervention includes:
- About clinician education Evidence-based management back pain
- Patient education using posters and handouts to highlight the benefits and harms of opioids
- Offer heat packs and anti-inflammatory pain relievers as alternative pain management treatments
- Rapid referral to outpatient clinics to avoid long waiting lists
- Audit information on opioid prescription rates and provide feedback to clinicians.
The key to the success of this approach is that we have worked with clinicians to develop appropriate non-opioid pain management treatments that are feasible in the field.
Further research is needed to evaluate this and other interventions aimed at reducing opioid prescribing in other settings, including general practitioner clinics.
A delicate approach is often required to avoid problems. unintended consequences To reduce opioid use.
It is important for people with back or neck pain to seek advice from their doctor or pharmacist before stopping opioids, especially if they are used in high doses for a long period of time. Undesirable effects of abruptly stopping the drug.
Our study provides convincing evidence that opioids play a limited role in the management of acute low back and neck pain. The challenge is to communicate this new information to clinicians and the public and translate this evidence into practice.
Christine LinProfessor, University of Sydney; andrew mclachlanHead of School and Dean of Pharmacy; University of Sydney; caitlin jonespostdoctoral researcher in the field of musculoskeletal health. University of Sydneyand christopher maherProfessor, Sydney School of Public Health, University of Sydney
A previous version of this article was published in June 2023.