Opioid analgesics are one of the most prescribed medications for relieving lower back and neck pain. A new study published in the medical journal Lancet has found that these analgesics do not alleviate "acute" lower back or neck pain (lasting up to 12 weeks) and can actually worsen the pain.
Prescribing opioid analgesics (such as Trodon, Moradol, Valoron, Sitradron...) for lower back and neck pain can also cause harm ranging from common side effects like nausea, constipation, and dizziness to abuse, addiction, poisoning, and death.
The researchers' findings indicate that this type of analgesic should not be recommended for acute back and neck pain.
Placebo effect
Scientists randomly selected 347 people with acute lower back and neck pain and gave them either an analgesic (oxycodone plus naloxone) or a placebo (a tablet that looked the same but had no active ingredients).
The participants took the analgesic or placebo for a maximum of six weeks.
Both groups of participants also received advice from doctors on how to return to normal activities and when to rest, and their condition was monitored for the following year. Results showed After six weeks of treatment, taking the analgesic did not lead to significant pain relief compared to the placebo.
Nor did they show any benefits for other problems such as physical function, quality of life, recovery time, or work absenteeism.
More people in the analgesic-treated group experienced nausea, constipation, and dizziness compared to those in the placebo group.
An analysis of the results after one year highlighted the potential long-term harm of analgesics even with short-term use. Compared to the placebo group, people in the analgesic group experienced slightly stronger pain and reported a higher risk of misuse (problems with concentration, mood or behavior, or using the analgesics differently from how they were prescribed).
What these results mean
In recent years, international guidelines for treating lower back pain have shifted the focus from analgesic treatment to non-medication-based treatments due to the proven limited benefits of such treatment and concerns about the harm caused by their use.
For acute lower back pain, guidelines recommend patient education and advice, and if necessary, pain medications such as ibuprofen. Opioid analgesics are recommended only when other treatments have failed or are not suitable.
Similarly, guidelines for neck pain discourage the use of opioids.
Change is possible
Complex problems such as opioid use require smart solutions, and another study recently conducted provides compelling evidence that opioid prescribing can be successfully reduced.
The study involved four hospital emergency departments, 269 clinicians, and 4,625 patients with lower back pain. The intervention consisted of:
educating clinicians on evidence-based
management of lower back pain educating patients
using posters and materials highlighting the benefits and harms of opioids providing
heat packs and nonsteroidal anti-inflammatory drugs as alternative treatments for pain relief
rapid referral tracking to clinics to avoid long waiting lists
analysis and feedback to clinicians on the rate of opioid prescribing
This intervention reduced the prescription of this type of medication from 63% to 51% of cases of lower back pain. The reduction in their use lasted for 30 months.
The key to this successful approach is that clinicians worked on developing appropriate non-opioid pain relief treatments that were feasible in their environment.
If patients with lower back pain or neck pain use opioid analgesics, especially in higher doses over a longer period of time, it is important for them to seek advice from their doctor or pharmacist before discontinuing the use of these medications to avoid unwanted effects when abruptly stopping their use.