Opioids may provide some short-term pain relief for patients with chronic low back pain, but the effect is not clinically significant within guideline-recommended doses, according to a study published in JAMA Internal Medicine.
The effects of opioid analgesics for treating patients with acute back pain could not be assessed due to a lack of evidence.
The review included data from 20 randomized clinical trials, including a total of 7,925 participants; 13 of these studies (with 3,419 participants) evaluated the short-term effects of opioid analgesics on chronic low back pain. No placebo-controlled trials enrolled patients with acute back pain.
The primary outcome that the researchers analyzed was pain, and they converted pain and disability outcomes to a 0 to 100 scale. Effects greater than 20 points were considered clinically significant.
In half of the trials that assessed patients with chronic low back pain, at least 50% of participants withdrew due to adverse events or lack of treatment efficacy. The researchers found moderate-quality evidence that opioid analgesics reduced pain in the short term, with a mean difference of -10.1. However, they found no clinically significant pain relief within the dose range evaluated (40.0 to 240.0 mg morphine equivalents per day).
- Abdel Shaheed C, Maher CG, Williams KA, et al. Efficacy, tolerability, and dose-dependent effects of opioid analgesics for low back pain: a systematic review and meta-analysis. JAMA Intern Med. Published online May 23, 2016. doi:10.1001/jamainternmed.2016.1251.