It also demonstrates that many patients do not tolerate the medicine, with half of the trial participants withdrawing because of adverse effects to the medication or lack of effect.
A new research from The George Institute for Global Health and the University of Sydney has found that opioids painkillers, a common treatment for low back pain, provide minimal benefit. The findings of the systematic review, published in JAMA Internal Medicine, also demonstrate that many patients do not tolerate the medicine, with half of the trial participants withdrawing because of adverse effects to the medication or lack of effect.
Professor Chris Maher, Head of the Musculoskeletal Division at The George Institute for Global Health, says the review provides some unique insights into management of low back pain.
“For people who can tolerate the medicine, taking an opioid analgesic such as oxycodone will reduce pain, but the effect is likely to be small. This result reinforces the recent US Centers for Disease Control and Prevention (CDC) recommendation that if opioids are used, they should be combined with non-drug options such as physiotherapy or non-opioid painkillers, as appropriate.”
The study also found that even at high doses – above recommended levels – the drugs still provided little clinical benefit.
“People have the mistaken belief that opioids are strong pain killers. When you look closely at the evidence from the low back pain trials, a completely different picture emerges,” said Maher.
Co-author of the review, Professor Andrew McLachlan from the Faculty of Pharmacy at the University of Sydney and Concord Hospital, says that more research is needed around the use of opioid medicines for treating low back pain, to understand how the long-term use of opioid analgesics impact patients.
“We do not yet understand the effects of the long term use of opioid analgesics, as no trials have followed up patients beyond three months. Importantly, we do know that these medicines can have significant harmful effects when used inappropriately or for longer periods of time. The recent CDC guideline for prescribing opioids for chronic pain provides some excellent advice for clinicians considering use of opioid analgesics for their patients,” Professor McLachlan said.
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