2023-07-01 12:22:04
Dubai, United Arab Emirates (CNN) — Opioids, one of the most commonly prescribed treatments for low back pain around the world, may not be effective, a new study has found.
Neck and lower back pain are common. In fact, globally, low back pain is the leading contributor to years lived with disability, while neck pain ranks fourth, according to an analysis of data conducted by the Global Burden of Disease Study 2021.
The North American Spine Association notes that low back pain is defined as acute when symptoms last up to six weeks, and chronic when they last for more than 12 weeks.
When it comes to managing this pain, doctors should carefully limit a patient’s use of opioids and, if prescribed, keep the treatment for a short period of time, according to community clinical guidelines. He also recommended that opioids be used for pain relief only if other drug treatments did not work, or if the person could not take them for personal reasons.
“Despite these guidelines, there is no evidence of their effectiveness in relieving pain, and opioid painkillers are still widely prescribed,” Christine Lane, a professor at the Institute of Musculoskeletal Health at the University of Sydney, Australia, and lead author of the latest study published in The Lancet Wednesday, said in a press release. For people with lower back and neck pain in many countries.
Because of the paucity of research on this topic, the scientists studied the effectiveness and safety of using opioids to treat a small group of 310 people. The patients had sought help for neck or lower back pain from primary care clinics or hospitals in Sydney between February 2016 and March 2022. At the start of the study, the participants were 44 years old, on average, with minimal to moderate pain. In the neck or lower back, or both for 12 weeks or less.
Study participants were randomly assigned to two groups: the first was given a combination of naloxone and about 20 micrograms of the opioid oxycodone daily for six weeks. Naloxone was used to prevent constipation, a common side effect of opioids, thus preventing the participants from knowing which group they belonged to. In the second, participants were given placebo pills.
Both groups received care advice from a physician they visited weekly who advised them to stay active, avoid bed rest and, if necessary, avoid other treatments, including non-opioid medications.
The authors found that in terms of effects on back and neck pain, opioids were no more beneficial than a placebo. After six weeks of treatment, the average pain score was 2.78 in the opioid group and 2.25 in the placebo group. It is a difference that has increased over time. More people in the opioid group experienced persistent pain at Weeks 26 and 52 than in the placebo group.
The authors also found that opioids are not only likely to relieve back and neck pain, and may also cause harm even after short- and moderate-term use.
The opioid group had worse mental health outcomes and reported nausea, dizziness and constipation than the placebo group. “We also know that prescribing opioid pain relievers even for a short period of time increases the risk of long-term abuse of opioids,” Lin said in a press release.
Opioids and pain
The study authors and experts not involved in the new study have theories about why opioids didn’t work out to be more beneficial than a placebo.
One possibility is that the back or neck pain of the opioid group may be the result of more underlying factors than the authors considered—factors known to respond poorly to opioid therapy, the experts said.
And the treated pain may be more chronic and recurrent than the type caused by acute injury, according to a commentary on the study by Dr. Mark D. Sullivan and Dr. Jane C. Ballantyne, who are not participants. Sullivan is professor of psychiatry and behavioral sciences, and Ballantine is professor emeritus of anesthesiology and pain medicine at the University of Washington.
“Participants were only required to be pain-free for one month prior to the current episode of spinal pain,” Sullivan and Ballantyne wrote. “If many of these participants had recurrent pain, this could be the reason for not responding to opioid therapy. A shift in low back pain has been reported over the course of a year.”
Sometimes areas of pain in the neck and back need to be treated separately, said Dr. John Finkenberg, who was not involved in the study and who specializes in spine surgery in San Diego.
“If someone has both, they have a systemic problem that occurs, whether it’s generalized arthritis or rheumatoid,” he added. “We have to be careful about patients who come in with both,” added Finkenberg, who is also president of the North American Spine Association.
The authors did not collect data about the care doctors provided at follow-up appointments, so they did not have details about whether patients followed any advice or its impact. In addition, only 57% of the participants reported their compliance with taking medication as prescribed. And among those, just over half kept more than 80% of their prescriptions.
Control back and neck pain
Given the findings that opioids carry more risk of harm than benefit, the authors believe that opioids should not be recommended for acute neck or low back pain.
“Instead, clinicians should be encouraged to focus on patient-centered approaches that may include tips for staying active and prescribing simple pain relievers,” Lynn said in the press release. “The good news is that most people with acute low back pain and neck pain recover naturally within 6 weeks,” she added.
Alternatives to opioids include nonsteroidal anti-inflammatory drugs, also known as NSAIDs, such as ibuprofen, naproxen and celecoxib.
Range-of-motion exercises that include stretching may also help to maintain or improve mobility.
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