The evidence calls for treatment guidelines to be changed.
According to a world-first trial led by the University of Sydney, opioids are no more effective than a placebo for treating acute back and neck pain and could even be harmful.
The research team argues that this evidence calls for an update to treatment guidelines, advising against using opioids for such conditions. It is a significant concern, given that more than 577 million people globally suffer from low back and neck pain at any given moment.
Despite a global push to reduce the use of opioids, in Australia, approximately 40 to 70 percent of those who present with neck and back complaints are prescribed opioids for their pain.
The OPAL trial recruited close to 350 participants from 157 primary care and emergency department sites. Participants with acute-meaning sudden and generally short-term back or neck pain were randomly allocated to a six-week course of a commonly prescribed opioid or a placebo.
Both groups also received standard care including advice to avoid bed rest and stay active. Participants were followed for 52 weeks.
The results of the trial were recently published in The Lancet.
What did the study find?
At six weeks, those who received opioids did not have better pain relief than those given the placebo.
Quality of life and pain outcomes at long-term follow-up were better in the placebo group.
Patients who received opioids were at a small but significantly higher risk of opioid misuse 12 months after their short course of medication.
The research team says that according to current back and neck pain guidelines opioids can be considered as a last resort if all other pharmacological options have failed, however, this study is evidence that opioids should not be recommended at all.
“We have clearly shown there is no benefit to prescribing an opioid for pain management in people with acute back or neck pain, and in fact, it could cause harm in the long-term even with only a short course of treatment,” said lead investigator Professor Christine Lin from Sydney Musculoskeletal Health, an initiative of the University of Sydney, Sydney Local Health District, and Northern Sydney Local Health District
“Opioids should not be recommended for acute back and neck pain full stop.
“Not even when other drug treatments are not able to be prescribed or have not been effective for a patient.”
The study complements previous research into opioid use for chronic (long-term) low back pain which found a small treatment benefit, but increased risk of harm.
Quality of life and pain outcomes at long-term follow-up were better in the placebo group.
Patients who received opioids were at a small but significantly higher risk of opioid misuse 12 months after their short course of medication.
The research team says that according to current back and neck pain guidelines opioids can be considered as a last resort if all other pharmacological options have failed, however, this study is evidence that opioids should not be recommended at all.
“We have clearly shown there is no benefit to prescribing an opioid for pain management in people with acute back or neck pain, and in fact, it could cause harm in the long-term even with only a short course of treatment,” said lead investigator Professor Christine Lin from Sydney Musculoskeletal Health, an initiative of the University of Sydney, Sydney Local Health District, and Northern Sydney Local Health District
“Opioids should not be recommended for acute back and neck pain full stop.
“Not even when other drug treatments are not able to be prescribed or have not been effective for a patient.”
The study complements previous research into opioid use for chronic (long-term) low back pain which found a small treatment benefit, but increased risk of harm.
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