New Study- Opioids No Better for Acute Neck and Back Pain Than Non-Opioid Treatment
A recent research study according to the Opioid Prevention for Aging & Longevity (OPAL), has found that there was no significant difference in pain scores for opioid analgesics versus placebo for acute lower back or neck pain.
Back and neck pain afflicts millions of American adults, driving many to seek relief from their family doctor or even the local emergency room. When these episodes of pain are acute and nonspecific — meaning there's no clear cause or explanation — it's generally advised to start off with everyday remedies and alternatives like heat therapy, massage or exercise.
If that's not doing the trick though, doctors may prescribe a short course of opioids, with the goal of relieving pain and improving a patient's function. But the results of a rigorous clinical trial published recently cast doubt on using opioids even in this situation. In a study of more than 340 patients suffering from low back or neck pain, a team of researchers found there was no difference in pain severity after six weeks between those who received opioids versus a placebo sugar pill.
"It was quite a surprise to us," says Andrew McLachlan, dean of pharmacy at the Sydney Pharmacy School and an author on the study, which was published Wednesday in The Lancet. "We thought there would be some pain relief, but overall there was no difference."
What's more, the study found those who received opioids had an elevated risk of misusing the drugs a year later, reinforcing the potential harms of turning to opiods for pain relief, even temporarily. While previous research has focused on treating chronic pain with opioids, this study is notable because it examines garden-variety back pain that lasts a shorter period of time, at most three months.
"This trial has clearly shown there is no benefit to prescribing a short course of an opioid medicine for pain management in people with acute back or neck pain, and in fact, it could cause harm in the long-term even with only a short course of treatment," co-author Andrew McLachlan, PhD, also from the University of Sydney, wrote in an email to MedPage Today.
Opioids may make your pain worse
Opioids should only be used for a short time after a surgical procedure or serious injury. When used for a long time, opioids may not reduce your pain as well as they did at first. Instead, taking opioids for a long time may make you feel worse pain. This is called opioid-induced hyperalgesia (OIH).
In response to the national opioid epidemic, under the direction of Dr. Jeanne Wei and Dr. Gohar Azhar, the O.P.A.L. Program is providing adults and their caregivers an opportunity to learn more about opioid pain medications, non-opioid pain medications and integrative medicine therapies like Tai Chi, Yoga, mindfulness meditation. In addition, we are educating older adults about the dangers of over-the-counter medications SUCH AS Tylenol, aspirin, advil, and aleve.
Opioid side effects
If you take prescription opioid pain medications, you are at increased risk for having side effects. Some common side effects include sleepiness, constipation and nausea. More serious side effects include confusion, shallow breathing, slowed heart rate and loss of consciousness. It is important to ask your doctor about these possible side effects if you are given a prescription for opioids.
Prescription opioid pain medications may affect your heart. Opioids are strong pain medications but are usually intended only for short-term use, such as after a surgery or other procedure. However, they often have unintended consequences for older adults, including problems with the heart:
increased risk of having atrial fibrillation
decreased heart rate and blood pressure
impaired heart function and could cause heart failure
increased risk of heart disease
Integrative therapies are called complementary therapies when they are used with standard medicine such as combining a non-opioid pain therapies such as massage therapy or ultrasound. Integrative therapies such as Tai Chi can also strengthen muscles and improve flexibility and posture; art and music therapy can help a person explore emotions and self-expression as well as reduce pain and also give a calming, relaxing effect. CBD has also been well received by patients suffering from neck and back pain.
Aromatherapy and mindfulness meditation has helped to ease chronic pain and discomforts of illness through distraction from the chronic pain. Mindfulness meditation is a form of concentration where a person observes the flow of inner thoughts, emotions and bodily sensations without judging them as good or bad. It is intended to reduce stress and decrease anxiety. Here are some products which may help with Pain, Anxiety, & Chronic Illness.
Integrative therapies do not have the side effects of medications. They may not work for everyone in the same manner. You may need to try more than one combination of therapies to determine what works best for you. They have the potential to help ease chronic non-cancer pain and other symptoms and to give you a better quality of life, better coping skills, and more options for controlling discomfort from chronic pain.
OPAL ran at 157 primary care or emergency department sites in Sydney from 2016 to 2022. It included 347 adult participants presenting with a primary complaint of lower back pain or neck pain, whose current episode had been 12 weeks or less, and who had spent at least 1 month prior to the episode pain-free in these areas.
New Guidance from the CDC
The new guidance opens in a new tab or window -- which covers acute, subacute, and chronic pain for primary care and other clinicians -- updates and replaces the controversial 2016 CDC opioid guideline opens in a new tab or window for chronic pain. The 2016 guideline was interpreted as imposing opens in a new tab or window strict opioid dose and duration limits and was misapplied by some organizations, leading the guideline authors to clarify their recommendations opens in a new tab or window in 2019.
No meaningful difference from placebo
The results of the new trial draw attention to an unexpected gap in our understanding of how well opioids work in the context of acute back pain. Patients who had new low back or neck pain for 12 weeks or fewer were recruited from more than 150 primary care clinics and emergency departments in Sydney, Australia, and randomly assigned to either the opioid group or the placebo group. The study took six years to complete.
The study focused on acute-onset back pain, which can be caused by everything from twisting or turning awkwardly to how you sleep, says McLachlan. For this type of nonspecific pain, he says, "you can't really take an X-ray and say, 'This is the problem.' "
Participants didn't know if they were receiving the medication or a placebo. The opioid group received a combination of oxycodone and naloxone, a medication that had the effect of minimizing gastrointestinal side effects related to the opioids, particularly constipation, so that participants wouldn't realize they were in the treatment group.
Opioids and digestion
Opioids (narcotics) are a type of prescription pain medication used for severe pain relief. They should usually be used only for a short time. Long-term opioid use can lead to negative side effects. Opioids may slow down muscles in your gut making it difficult to have a bowel movement (constipation). They may also make it harder for your bladder muscles to pass urine or empty your bladder (urinary retention).
Prior research indicates that opioids can have a small but detectable effect on relieving chronic pain, McLachlan says. "This trial fills the gap by showing, even though people may have moderate to severe low back pain, opioids don't seem to be the choice for them because they don't provide any benefit" over this shorter period of time.
At six weeks, there was no significant difference in the pain scores between the two groups. The same was true after 12 weeks.McLachlan says they focused on pain severity after six weeks because that would give enough time to gradually increase dosing until patients reached their optimal dose, up to 20 milligrams of oxycodone a day.
The study showed that taking opioids appeared to confer twice as much additional risk. When participants were surveyed a year later to gauge whether they had certain risk factors for opioid misuse, 20% of those in the opioid group had a score indicating behaviors that a doctor would find problematic when prescribing opioids. That's compared to 10% in the placebo group.
Findings could improve health outcomes
"It's a well-designed trial," says Richard Deyo, a family medicine doctor and an emeritus professor at Oregon Health and Science University. The study underscores a significant blind spot in the evidence around the prescribing of opioids for acute back pain, says Deyo, so much so that it's somewhat shocking a study like this hadn't been done sooner. "This is just one trial, but if its findings are true, then it looks like the benefits of opioid treatment for a back pain episode are less and the risks are higher than we've assumed," he says, noting the increased risk of opioid misuse among those who received opioids in the study.
This study shouldn't be taken as the final word, but Bicket says it does add further weight to the idea that other treatments besides prescription opioids should be emphasized for low back pain. Other treatments such as CBD and Delta 8. For additional information, you can read: CBD vs. Opioids: Which is the Better Pain Management Option?
Opioid analgesia for acute low back pain and neck pain (the OPAL trial): a randomised placebo-controlled trial. Caitlin M P Jones, PhD, Prof Richard O Day, MD, Prof Bart W Koes, PhD, Prof Jane Latimer, PhD, Prof Chris G Maher, DMedSc, Prof Andrew J McLachlan, PhD, et al
Published Print: 2023-06
Update policy: https://doi.org/10.1016/elsevier_cm_policy
CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022. Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. MMWR Recomm Rep 2022;71(No. RR-3):1–95. DOI: http://dx.doi.org/10.15585/mmwr.rr7103a1.