Trials show no benefits of prescribing opioids for people with acute back or neck pain

Opioid pain relievers are no more effective than placebo in relieving acute back and neck pain, and may even be harmful, according to a world-first study led by the University of Sydney.

The researchers say this is evidence that treatment guidelines should be updated to avoid using opioids for this purpose.

Over 577 million people worldwide experience back and neck pain at one time.

About 40 to 70 percent of people with neck and back complaints in Australia are prescribed opioids for pain, despite global efforts to reduce opioid use.

The OPAL trial recruited nearly 350 participants from 157 primary care and emergency department facilities. Participants with acute, sudden, generally short-term back or neck pain were randomly assigned to a 6-week course of commonly prescribed opioids or 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 are presented below. lancet today.

What did the study find?

• At 6 weeks, pain relief in opioid-treated patients was no better than in placebo-treated patients.
• Quality of life and pain outcomes at long-term follow-up were better in the placebo group.
• Patients who received opioids had a small but significantly higher risk of opioid misuse 12 months after short-term dosing.

Current back pain and neck pain guidelines allow the research team to consider opioids as a last resort when all other pharmacological options have failed, but this study suggests that opioids should be recommended at all. It is said to be evidence that it is not.

“We have clearly demonstrated that there is no benefit to prescribing opioids for pain relief in people with acute back and neck pain. “It could have an impact,” said Professor Reed.Professor Christine Lynn, researcher in Sydney Musculoskeletal Health, an initiative of the University of Sydney, Sydney Community Health District and North Sydney Community Health District

“Opioids should not be recommended outright for acute back and neck pain.

“Even if other drug treatments cannot be prescribed or have not worked for the patient.”

This study, which complements previous research on the use of opioids for chronic (long-term) low back pain, found a small therapeutic effect but an increased risk of harm.

Driving reduction in opioid use globally

Reducing opioid overuse is a global health priority. Medical authorities around the world have warned that opioids should only be used when there is evidence that the benefits outweigh the harm, due to the significant risk of harm to individuals and society.

Co-author Professor Chris Maher notes that in recent years, the focus of treating back pain has shifted from opioids to non-opioids, with more emphasis on physical and psychological therapy and simple pain relievers such as anti-inflammatory drugs (called NSAIDs). said to have been placed. .

“This study suggests that first-line management of acute back and neck pain should rely on reassurance and advice to stay active and, if needed, simple analgesics such as non-steroidal anti-inflammatory drugs.” It’s further evidence that,” Professor Maher said. Sydney musculoskeletal health.

Harm from Opioid Use

Professor Andrew McLachlan, Dean and collaborator at Sydney University of Pharmacy, said the Lancet study is important as Australia faces rising opioid use and should have an impact on the prescribing and dispensing of these medicines. said.

According to the Australian Therapeutic Goods Administration, every day in Australia, nearly 150 people are hospitalized for problems related to opioid use, 14 are admitted to emergency departments and three die from harm from prescription opioid use. there is

The potential adverse effects of opioids are well known. They range from minor harms such as constipation and drowsiness to major harms such as addiction, addiction, overdose, and even untimely death.

The results of the OPAL trial further reinforce the need to re-evaluate the use of opioid analgesics given their limited evidence of benefit and known risks of serious harm. ”

Professor Andrew MacLachlan, Dean, Sydney School of Pharmacy

The authors point to some limitations of the study, including data gaps due to underrepresentation and adherence issues consistent with other low back pain drug trials. They suggest that neither is likely to have influenced the main results of the study.

The trial was conducted jointly by the University of Sydney, the George Institute of Global Health, New South Wales, Sydney St Vincent’s Hospital, Sydney Regional Health District, and the Erasmus University Medical Center in the Netherlands.