Evidence Steers Away from Opioids for Chronic Back Pain Relief

Although patients commonly take opioids to relieve chronic back pain, there is no concrete evidence supporting this strategy.

A team of Australian researchers set out to determine no only whether opioids were effective in this population, but also if the drugs were well-tolerated. To do this, they evaluated clinical trial results published in databases including Medline, EMBASE, CENTRAL, CINAHL, and PsycINFO.

A total of 3,419 participants with chronic back pain were included from 13 clinical trials. Notably, 50% of the participants in half of those 13 trials discontinued due to either adverse events or lack of efficacy.

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The patients described their pain and disability using a 0 to 100 scale — anything over 20 was considered clinically important. Opioid doses ranged from 40 to 240 mg morphine equivalents a day. Medications included oral hydromorphone, oxymorphone, morphine, tramadol monotherapy, or in combination with paracetamol, tapentadol, oxycodone monotherapy, oxycodone in combination with naloxone, or naltrexone, transdermal buprenorphine, transdermal fentanyl, and hydrocodone.

“Meta-regression revealed a 12.0-point greater pain relief for every one log unit increase in morphine equivalent dose,” the researchers wrote in JAMA Internal Medicine. However, for the doses included in the trials, there was no clinically important pain relief observed.

“For people with chronic low back pain who tolerate the medicine, opioid analgesics provide modest short-term pain relief, but the effect is not likely to be clinically important within guideline-recommended doses,” the researchers specified.

There was little data on disability outcomes, but one study involving morphine did not show clinical significance. The team stressed that this research does not include acute back pain.

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