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Opioids are one of the most frequently prescribed pain relievers for people with lower back and neck pain.

In Australia, about 40% of people with low back and neck pain who see their GP are prescribed opioids, and 70% of people with low back pain who visit a hospital emergency department are taking opioids such as oxycodone. But a new study published in July in the medical journal The Lancet found that opioids do not relieve “acute” lower back or neck pain (lasting up to 12 weeks) and can lead to worse pain. Prescribing opioids to treat lower back and neck pain can cause harm ranging from common side effects (such as nausea, constipation, and dizziness) to misuse, addiction, poisoning, and death.

The results of the new study show that “opioids should not be recommended for the treatment of acute low back pain or neck pain.” “There is an urgent need to change the prescribing of low back and neck pain in Australia and globally to reduce opioid-related harm.” This is according to what was reported by the scientific website “Science Alert”.

Comparing opioids with a placebo in the scientific trial, study researchers randomly assigned 347 people with severe lower back pain and neck pain to take either an opioid (oxycodone plus naloxone) or a placebo (a pill that looks similar but has no active ingredients). ).

Oxycodone is an opioid pain medication that can be given orally. Naloxone, an opioid reversal drug, reduces the severity of constipation while not disrupting the pain-relieving effects of oxycodone.

Participants took opioids or placebo for a maximum of six weeks. People in both groups also received education and advice from their treating physician. They then evaluated the results over a one-year period.

The researchers found that after six weeks of treatment, taking opioids did not provide better pain relief compared to placebo. There were no benefits for other outcomes such as physical function, quality of life, recovery time, or work absence. More people in the opioid-treated group experienced nausea, constipation and dizziness than in the placebo group.

These results after one year highlight the potential long-term harm of opioids even with short-term use.

Compared with the placebo group, people in the opioid group experienced slightly worse pain and reported a higher risk of opioid misuse (problems with their thinking, mood, or behavior, or using opioids differently than the way they were prescribed).

More people in the opioid group also reported pain after one year (66 people compared to 50 people in the placebo group).

What does this mean for opioid prescribing?

In recent years, international low back pain guidelines have shifted the focus of treatment from pharmacological to non-pharmacological therapy due to evidence of limited benefits of treatment and concern about drug-related harms.

For acute low back pain, guidelines recommend patient education, counseling and, if necessary, anti-inflammatory medications such as ibuprofen. Opioids are only recommended when other treatments have not worked or are not appropriate.

Likewise, neck pain guidelines discourage the use of opioids.

In this context, recent research clearly shows that the benefits of opioids do not outweigh the potential harms in people who suffer from severe lower back pain and neck pain. Instead of recommending the use of opioids for these conditions in selected circumstances, opioids should be discouraged unconditionally.

It is worth noting that the study included four hospital emergency departments, 269 doctors, and 4,625 patients suffering from low back pain.