Opioids—prescription pain relief medications including hydrocodone, oxycodone, and morphine—have been commonly used for decades as a treatment for back pain. With the United States now facing a crisis of opioid addiction, there have been calls to rein in the frequency with which these medications are prescribed and to find other options for treating chronic pain. In the US, more than half of the patients being prescribed opioids for pain relief share one complaint: Chronic low back pain.
If you suffer from lower back pain, even while you understand the need to curb widespread addiction and abuse of these drugs, you might feel discouraged that it’s one less potential treatment option. You may not need to be so worried, however: A recent meta-analysis published in JAMA Internal Medicine found that opioids were not especially effective at treating lower back pain. The authors, led by Christina Abdel Shaheed, PhD, from the George Institute for Global Health in Sydney and the School of Medicine at Western Sydney University in Penrith, Australia, looked at 20 randomized, controlled trials to evaluate the efficacy of opioids as a treatment for lower back pain and found that they did not provide significant pain relief.
The researchers looked at both pain and disability outcomes for the patients in the studies. These were converted to a common 100-point scale, and the authors deemed results that were over 20 points significant. While it is arguable that simplifying the data in this way may lose some of the nuances, it also allows for a more straightforward overview of the outcomes. The researchers found that evidence was lacking to support the long-term efficacy of opioids and the use of opioids for acute lower back pain, and that the drugs’ impact on chronic lower back pain was modest.
Most of the research that the authors surveyed—13 of the 20 studies—looked at prescription opioids’ effect on chronic lower back pain. The authors found that “clinically important pain relief” was not observed in doses equivalent to 40 to 240 mg of morphine taken daily. Though the data showed some evidence that the drugs could be more effective at larger doses, it’s important to note that the FDA recommends against doses over the equivalent of 200 mg of morphine. At that dose, not only is there a greater risk of dependency and side effects, the risk of life-threatening complications is too great.
This ties in with another important point the authors make. In reviewing these studies, they noted that many of the studies excluded participants who did not tolerate or who did not adequately respond to prescription opioids. That means that the results only include people whose pain could be helped by the drugs; had the numbers accounted for patients who were dropped during earlier phases, the amount of pain reduction attributable to opioids would be even less.
This meta-analysis implies that the potential gain in pain relief from prescription opioid analgesics is, for many patients, not enough to outweigh the risks. If you are suffering from chronic lower back pain, it’s important to know that there are other treatment options. While pain relievers like opioids may reduce the symptoms, they don’t actually treat what is causing the pain. To find real relief, you need to start from an accurate diagnosis. Call the Spine Institute Northwest at 206-496-0630, or upload your MRI or CT scan for a free review by our physicians.