Opioid painkillers ‘show little benefit for back pain’

Common and regularly prescribed painkillers are ineffective against back pain, according to a study published in the journal JAMA Internal Medicine.

The research finds that opioids including tramadol, oxycodone and morphine only provide ‘minimal benefit’ for lower back pain, even at high doses.

Although the trial did not look at the benefits of codeine because of a lack of available data, the researchers believe that their findings extend to this drug as well.

This major review of clinical evidence, carried out by the George Institute for Global Health in Sydney, suggests that because the drugs are highly addictive, they could be doing more harm than good.

Although the drugs reduce pain slightly, the researchers believe that they are not clinically effective. Side effects of opioid usage include dizziness, which can lead to further injury and fatal falls.

Having looked at 20 clinical trials involving 7,295 patients, the researchers found that half of patients taking opioids for back pain either suffered side effects or stopped taking the drugs entirely.

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

Instant analysis
The paper looked at 20 randomised controlled trials. Seventeen compared opiate medication versus placebo; three compared different opiate drugs. Most of these trials were funded by pharmaceutical companies.

Researchers sought to quantify improvement of pain within each of these studies. On a scale of zero to 100, a 0-10 improvement score was deemed to be ‘minimal difference’; more than 20 was deemed to be ‘clinically important’.

For short- and medium-term back pain (up to 12 months), opiate medication did help, but was judged to be of ‘minimal’ benefit. Larger doses (above 240mg a day) also favourably increased pain relief.
 
Powerful opiate medications, like oxycodone and buprenorphine patches, were seen to be effective in the short to intermediate term.

However, the study does challenge the idea that long-term back pain should be medicated with opiate-derivative medications when the clinical effectiveness of doing so is only mild.

Taking such medication may hinder patients by allowing pain to become established and ‘chronic’, instead of treating the problem with exercise and physical therapy which are shown to have a stronger effect.
RM
Research score: 3/5