24 May 2016

Opioid painkillers provide little relief for sufferers of low back pain, even in high doses.

This is the main finding of a systematic review of 20 trials that looked at how effective a variety of opioid painkillers were, including morphine, oxycodone (e.g. Endone), tramadol and paracetamol and codeine combination.

The review shows they are no better or worse than NSAIDs (non-steroidal anti-inflammatory drugs such as ibuprofen) for treating low back pain but that the side effects associated with opioids are potentially greater.

The review, published in JAMA Internal Medicine, confirms opioid analgesics relieve pain in the short and intermediate term for people with chronic (ongoing) but not acute low back pain. However, the effect is likely to be small.

Furthermore, it highlights high rates of adverse effects, with half of the trial participants withdrawing because they did not tolerate or respond to the medicine.

“People have this mistaken belief that opioids are strong pain killers,” says Professor Chris Maher, co-author and head of the musculoskeletal division at The George Institute. “When you look closely at the evidence a completely different picture emerges.”

Even at high doses, the magnitude of the effect is less than the accepted thresholds for a clinically important treatment effect on pain, the report states.

“This result reinforces the recent US centers for Disease Control and Prevention recommendation that if opioids are used, they should be combined with non-drug options such as physiotherapy or non-opioid painkillers, as appropriate,” Dr Maher says.

In Australia, 40% of patients who see a GP for this condition are prescribed an opioid.

Last Reviewed: 24/05/2016

Reproduced with kind permission from 6minutes.com.au.


Online First >
Original Investigation | May 23, 2016
Efficacy, Tolerability, and Dose-Dependent Effects of Opioid Analgesics for Low Back Pain
A Systematic Review and Meta-analysis.