March 4, 2024


Despite the risks associated with opioid use, they are often prescribed as first-line treatment for acute low back and neck pain. Researchers found that placebos were more effective than opioids in reducing acute short-term back and neck pain and called for changes to current prescribing guidelines.

Globally, low back pain and neck pain are common. Clinical guidelines recommend that opioids (a class of drugs that mimic the opiate analgesic properties of the poppy plant) should be prescribed when other forms of analgesics are contraindicated or ineffective.

Despite these guidelines, as many as two thirds of Australians use opioids as first-line treatment after developing low back and neck pain.according to CDC (CDC) data show that the 2020 U.S. opioid dispense rate was 43.3 prescriptions per 100 people. The U.S. Centers for Disease Control and Prevention, the U.K.’s National Institute for Health and Care Excellence, and the Australian Commission on Healthcare Safety and Quality have all called for a reduction in opioid prescribing.

While opioids are effective in reducing pain, they can also produce unwanted side effects such as dependence, misuse, and overdose. Also, there’s no strong evidence that they’re effective in treating acute back and neck pain. A study led by researchers at the University of Sydney in Australia examined the short- and long-term effectiveness and safety of using opioids for acute low back and neck pain. This is the first study to do so.

The researchers recruited 347 participants whose main complaint was acute low back pain, acute neck pain, or both. In this study, “acute” was defined as moderate pain lasting at least 12 weeks or less. were randomly assigned to receive placebo or the opioid oxycodone (up to 20 mg per day) for six weeks. Participants were followed for 12 months. Both groups received standard care, including avoiding bed rest and maintaining mobility, and pain severity was measured at six weeks.

Oxycodone—sold as OxyContin or Endone and often called “oxy”—is an effective pain reliever used to treat moderate to severe pain. It acts directly on opioid receptors in the central nervous system, reducing pain by interrupting the way nerves send pain signals between the body and the brain.

The study found that after six weeks, participants who received opioids did not experience any better pain relief than those who received a placebo. Even short-term use of opioids did not reduce pain compared with placebo and resulted in small increases in pain over the medium and long term. More people in the placebo group recovered within the first 14 days than in the opioid group.

Quality of life and pain were better in the placebo group in the long run. The researchers found that at 12 months, participants taking opioids had a “small but significantly higher” risk of substance abuse.

“We’ve clearly shown that there is no benefit to prescribing opioids for pain management to people with acute back or neck pain, and in fact it can cause long-term harm even when only short-term treatment is given,” Christine said. .” Lin, the corresponding author of the study.

Findings suggest no benefit of prescribing opioids for acute back and neck pain, researchers say Study in 2016 Studies using opioids for chronic long-term low back pain have found small treatment benefits but increased risk of harm.

“Opioids should not be recommended for acute back and neck pain,” Lin said. “Not even when other medical treatments can’t be prescribed or don’t work for the patient.”

Treatment should not rely on opioids, but instead focus on physical and psychological interventions and non-opioid pain relievers, the researchers said.

“This study provides further evidence that first-line treatment of acute low back and neck pain should rely on reassurance and advice to stay active and use simple analgesics such as NSAIDs when needed,” said Chris Maher Said he was a researcher. co-author of the study.

They said the study’s findings should influence opioid prescribing, which is especially important given global concerns about the risks of opioid use.

“The possible harmful effects of opioids are well known,” said Andrew McLachlan, another co-author of the study. “They range from minor injuries such as constipation and lethargy to major injuries such as dependence, addiction, overdose, and even accidental death.”

Clinical guidelines should be updated to advise against prescribing opioids for acute neck and low back pain, researchers say.

The study was published in the journal Lancet.

source: University of Sydney