One of the most often given medications for pain relief in patients with neck and low back pain is opioids. In Australia, opioids like oxycodone are prescribed to about 40% of patients with low back and neck pain who visit their general practitioner and 70% of patients with low back pain who attend a hospital emergency room.
However, our latest research—which was published in the July issue of the Lancet medical journal—found that opioids both exacerbate and fail to alleviate “acute” low back or neck pain, which can last up to 12 weeks.
In addition to usual side effects including nausea, constipation, and dizziness, prescribing opioids for low back and neck pain can have serious consequences like overuse, dependency, poisoning, and even death.
According to our research, opioids shouldn’t be prescribed for sudden neck or low back discomfort. In Australia and around the world, a shift in the way low back and neck pain are prescribed is desperately needed to lessen the negative effects of opiate use.
Contrasting Opioids with a Sham
In our experiment, 347 patients with acute neck and low back pain were randomised to either a placebo (a tablet that looked the same but had no active ingredients) or an opioid (oxycodone + naloxone).
One opioid pain reliever that is administered orally is oxycodone. The opioid-reversal medication naloxone lessens constipation’s intensity without interfering with oxycodone’s ability to relieve pain.
For a maximum of six weeks, the participants took either the opioid or a placebo.
Additionally, the treating physician provided instruction and guidance to the individuals in both groups. Advice on getting back to their regular activities and avoiding bed rest is one example of this.
We evaluated their results throughout a whole year.
We discovered what?
Opioids did not provide greater pain relief than a placebo after six weeks of treatment.
Other outcomes including quality of life, physical function, healing duration, or work absenteeism did not show any benefits either.
Compared to the placebo group, a higher number of patients in the opioid treatment group reported experiencing nausea, constipation, and dizziness.
Findings after a year show that even with brief usage, opioids may have long-term negative effects. People in the opioid group reported a higher risk of opioid abuse (issues with their thinking, emotions, or behaviour, or using opioids differently from how the drugs were prescribed) and experienced slightly worse pain than those in the placebo group.
At one year, 66 members of the opioid group reported pain, compared to 50 members of the placebo group.
How will this affect the prescription of opioids?
In light of limited treatment advantages and concerns about medication-related risk, international recommendations for low back pain have recently changed the focus of treatment from pharmacological to non-pharmacological approaches.
Guidelines suggest providing patient education and advice, as well as anti-inflammatory pain medications such ibuprofen if necessary, for acute low back pain. Opioids are only advised in cases where no other course of treatment is suitable or has failed.
Similar guidelines for neck discomfort prohibit the use of opioids.
Our most recent research unequivocally shows that in patients with acute neck and low back pain, the advantages of opioids do not exceed potential risks.
Opioids should be categorically opposed to being recommended for these conditions under certain situations.
Change is conceivable.
Complicated issues like opioid abuse require clever solutions, and our most recent study offers compelling evidence that the number of prescriptions for opioids can be successfully decreased.
Four hospital emergency rooms, 269 physicians, and 4,625 patients with low back pain were all engaged in the study. Included in the intervention were:
Teaching clinicians about the evidence-based treatment of low back pain; educating patients about the advantages and disadvantages of opioids through posters and handouts; offering heat packs and anti-inflammatory pain medications as alternatives to opioids; expediting referrals to outpatient clinics to reduce waiting times; auditing and providing feedback to clinicians regarding opioid prescribing rates.
With this strategy, the percentage of low back pain presentations who received an opioid prescription fell from 63% to 51%. For a duration of 30 months, the decrease persisted.
The secret to this approach’s success is that we collaborated with doctors to create appropriate, non-opioid pain management therapies that made sense in their context.
To reduce the prescribing of opioids in other settings, such as general practitioner clinics, more research is required to assess this and other strategies.
When trying to reduce opioid use, a nuanced strategy is frequently required to prevent unintended outcomes.
It’s crucial that patients with low back pain or neck pain who use opioids, especially those taking larger dosages for longer periods of time, see their physician or chemist before quitting these medications in order to prevent unpleasant side effects from stopping them suddenly.
Our study offers strong evidence that the use of opioids to treat acute neck and low back pain is not recommended. Educating physicians and the public about this new information and putting the evidence into practise are the challenges.
Professor Christine Lin of the University of Sydney; Dean of Pharmacy and Head of School Andrew McLachlan; Professor Christopher Maher of the Sydney School of Public Health of the University of Sydney; and Postdoctoral Research Associate Caitlin Jones in the field of musculoskeletal health
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