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.

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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).


  1. 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.