2023-06-30 16:18:51
Opioid painkillers are no more effective than a placebo in relieving acute back and neck pain and may even be harmful, according to a study by the University of Sydney and published June 28, 2023 in the journal The Lancet (10.1016/S0140-6736(23)00404-X). According to the researchers, this is evidence that treatment guidelines should be updated to advise once morest the use of opioids for this purpose.
40-70% of pain prescriptions in Australia
More than 577 million people worldwide suffer from low back pain and neck pain. Despite global efforts to reduce opioid use, in Australia around 40-70% of people with neck and back pain are prescribed opioids for pain relief.
The OPAL study recruited nearly 350 participants from 157 primary care centers and emergency departments. Participants with acute — that is, sudden and usually short-lived — pain in the back or neck were randomly assigned to a six-week course of a commonly prescribed opioid and a placebo.
Both groups also received standard care, including advice to avoid bed rest and stay active. Participants were followed for 52 weeks. The objective of the study was to observe the efficacy and safety of a short, judicious course of an opioid analgesic for acute low back pain and neck pain.
Study results
After six weeks, people who received opioids had no better pain relief than those who received a placebo.
Quality of life and evolution of pain during long-term follow-up were better in the placebo group.
Patients who received opioids had a low but significantly higher risk of opioid misuse 12 months following their short course of medication.
The research team indicates that, according to current guidelines for back and neck pain, opioids may be considered as a last resort if all other pharmacological options have failed, but that this study proves that opioids should not be recommended in the first place. everything, because it might be harmful in the long term, even with a short course of treatment.
According to the authors, this study complements previous research on the use of opioids for chronic low back pain, which found a slight benefit for treatment, but an increased risk of harm.
Global effort to reduce opioid use
Reducing the overuse of opioids is a global health priority. Medical authorities around the world have warned that due to the significant risk of harm to individuals and society, opioids should only be used when the benefits are proven to outweigh the harms.
Professor Chris Maher, co-author of the study, said that over the past few years opioid treatments for low back pain have been replaced by non-opioid treatments, with a focus on physical and psychological therapies and on simple analgesics such as anti-inflammatories (called NSAIDs).
Harm caused by opioid use
Professor Andrew McLachlan, dean of the Sydney School of Pharmacy and co-investigator, said the study of the Lancet was significant and is expected to influence the prescribing and dispensing of these drugs as Australia faces increasing rates of opioid use.
According to Therapeutic Goods Administration Australian, Every day in Australia, nearly 150 hospitalizations and 14 emergency room admissions are linked to opioid use, and three people die from the adverse consequences of prescription opioid use.
The possible harmful effects of opioids are well known. They range from minor effects such as constipation and drowsiness to major effects such as dependence, habituation, overdose and even unintentional death according to Professor McLachlan.
The results of the OPAL study further reinforce the need to re-evaluate the use of opioid analgesics, as the evidence for their usefulness is limited and the risk of significant harmful effects is known.
References & Sources:
– Journal The Lancet (10.1016/S0140-6736(23)00404-X)
– English press release of the study (via Eurekalert.org)
Persons responsible and involved in the writing of this dossier:
Seheno Harinjato (editor at Creapharma.ch, responsible for infographics).
Date of last update of the file:
30.06.2023
Photo credits :
Creapharma.ch, Adobe Stock, © 2023 Pixabay. Image d’illustration.
Infographic credit:
Pharmanetis Sàrl (Creapharma.ch).
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