Opioids Often Ineffective for Low Back Pain

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People with chronic low back pain are sometimes prescribed opioids for pain relief, but a review of studies has found them generally ineffective.

The analysis, in JAMA Internal Medicine, pooled data from 20 high-quality randomized controlled trials that included 7,295 participants. The studies tested various narcotics; most of the studies were funded by pharmaceutical companies. Seventeen of the studies compared the opioid with a placebo, and three compared two opioids with each other. None had a follow-up longer than 12 weeks.

The drugs relieved pain slightly, but the effects were not clinically significant, and the medicines did little to improve disability. There was some evidence that larger doses worked better, but most trials had high dropout rates, some up to 75 percent, because of adverse side effects or inefficacy.

Measured on a 100-point scale, the magnitude of relief did not reach the 20-point level the researchers defined as clinically effective, little different from Nsaids like aspirin.

The lead author, Andrew J. McLachlan, a professor of pharmacy at the University of Sydney, said that often the solution for back pain is exercise regimens, staying active and reassurance from the doctor that the pain will go away.

“All these trials point in the same direction,” he said, “and this gives us the information to make decisions about clinical care. The first question is: Will these medicines help, and will they be safe?”