Opioid pain relievers not helpful for back & neck pain, carry misuse risks

SYDNEY: Opioid pain relievers have no benefit for people suffering from acute lower back and neck pain, and rather carry misuse risks, warned a study published in The Lancet.

Results of the first randomised controlled trial to investigate the safety and efficacy of opioid pain relievers for acute lower back and neck pain with a follow-up of one year, showed there was no significant difference in pain levels in patients with lower back or neck pain who were given opioid pain relievers compared to those given a placebo.

Further, it carried the risk of future dependence, misuse, and overdose.

Lower back and neck pain are very common worldwide. Clinical guidelines currently recommend opioid pain relievers for patients where other treatments have failed or are contraindicated, but there are concerns around the strength of the evidence to support this recommendation.

“Our study now suggests that they could be making patients’ pain levels worse in the medium and long term. As well as not providing patients with the pain relief intended, we also know that being prescribed opioid pain relievers even for a short period of time increases the risk of opioid misuse long term,” said Prof Christine Lin from the University of Sydney.

“Considering all the evidence and known risks, we firmly believe doctors should not prescribe opioid pain relievers for new episodes of lower back and neck pain.

“Lower back and neck pain can severely impact patients’ quality of life, so we need to offer them the best options to help manage their pain, but opioid pain relievers do not work and carry serious risks. Instead, doctors should be encouraged to focus on patient-centred approaches that could include advice to stay active, and simple pain relievers,” Lin added.

The study took place across 157 sites in Australia between 2016 and 2021. It included 347 participants who had already been experiencing lower back pain, neck pain, or both for up to 12 weeks.

All participants received guideline care (reassurance and advice to stay active), while 174 were given opioid pain relievers and the other 173 were given a placebo for up to six weeks.

There was no significant difference in pain scores at six weeks between the opioid and placebo groups – with average pain scores out of 10 being 2.8 in the opioid group compared to 2.3 in placebo group. There was no difference in overall number of participants reporting an adverse event between treatment groups, however, there were more reports of nausea, constipation, and dizziness in the opioid group.

Participants in the opioid group had a greater risk of opioid misuse after one year. Risk of misuse was significantly higher in the opioid group after one year – 20 per cent compared to 10 per cent in placebo, the study showed.