Treating Chronic Back Pain With Opioids

Opioids, an effective treatment for acute pain, are sometimes prescribed for chronic back pain. Researchers systematically reviewed the literature to determine the prevalence and efficacy of opioid treatment for chronic back pain. They also assessed the association between this treatment and substance use disorders and prescription medication misuse.

• The prevalence of opioid prescribing for chronic back pain ranged from 3% to 66% across 11 studies.
• Pain decreased nonsignificantly from baseline with opioid treatment in a meta-analysis of data from 5 studies.
• Opioids had better efficacy than placebo or nonopioids in 4 of 6 studies of short-term (<16 weeks) treatment.
• The prevalence of a current substance use disorder in patients receiving opioids for chronic back pain ranged from 3% to 43% across 4 studies, although the studies generally were of poor quality. In the highest quality study, the prevalence was 23%, the same as in a comparison group of patients with chronic back pain who had not received opioid treatment.
• The prevalence of prescription medication misuse in patients receiving opioids for chronic back pain was 5% to 24% across 5 studies, although these studies generally did not consider whether the misuse might have been due to inadequate pain relief.

Comments:

Obviously, we need better treatments for chronic back pain. Opioids seem to be an option at least in the short term. However, their efficacy is not particularly convincing and long-term benefit is unknown. Further, the possibility of a co-existing substance disorder has to be considered and addressed.

Richard Saitz, MD, MPH

Reference:

Martell BA, O’Connor P, Kerns RD, et al. Opioid treatment for chronic back pain: prevalence, efficacy, and association with addiction. Ann Intern Med. 2007;146(2):116–127.