Opioids yielded no difference in pain severity for low back, neck pain vs. placebo
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Key takeaways:
- Opioids may not significantly reduce pain severity for acute nonspecific low back or neck pain.
- Researchers recommend low back pain management should focus on nonpharmacological treatments.
Results published in The Lancet showed opioids yielded no difference in pain severity for adults with low back and neck pain when compared with placebo.
“This finding calls for a change in the frequent use of opioids for these conditions,” Caitlin M. P. Jones, PhD, faculty of medicine and health at The University of Sydney, and colleagues wrote.
Jones and colleagues randomly assigned 347 adults with at least 12 weeks of low back pain, neck pain or both of at least moderate pain severity to receive guideline-recommended care plus either an opioid (n=174) or placebo (n=173) for up to 6 weeks. Researchers considered pain severity at 6 weeks measured with the pain severity subscale of the Brief Pain Inventory as the primary outcome and collected data at baseline and at 2, 4, 6, 12, 26 and 52 weeks.
Overall, 89% of patients were included in the primary analysis. Results showed no significant differences in mean pain scores at 6 weeks between the opioid and control groups (2.78 vs. 2.25). Researchers also found a significant difference in the Roland-Morris Disability Questionnaire for patients with low back pain, and this favored the placebo group at 6 weeks. Although the opioid and placebo groups had no significant differences in quality of life on the physical function subscale, researchers found a small but significant difference for the mental health subscale at 6 and 12 weeks favoring the placebo group.
In addition, 7.5% of patients in the opioid group reported opioid-related adverse events compared with 3.5% of patients in the placebo-controlled group.
“We report a small but significant risk of harm at 1 year even after short-term [opioid] use. This finding is counter to guidelines, which recommend that opioids can be used judiciously for acute back pain, given that we found that there are no benefits but there is risk of harm,” the researchers wrote in the study. “Our findings do, however, support the changes in guideline recommendations for low back pain management, which have seen a shift in focus from pharmacological to nonpharmacological treatments, such as physical and psychological therapies.”
Collapse
Jones CMP, et al. Lancet. 2023;doi:10.1016/S0140-6736(23)00404-X.
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