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Related Experiment Videos

Opioids for low back pain.

Richard A Deyo1, Michael Von Korff2, David Duhrkoop3

  • 1Departments of Family Medicine, Internal Medicine, and Public Health and Preventive Medicine and Oregon Institute for Occupational Health Sciences, Oregon Health and Science University, Portland, OR 97239, USA Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA deyor@ohsu.edu.

BMJ (Clinical Research Ed.)
|January 7, 2015
PubMed
Summary

Opioid prescriptions for back pain are common but offer limited long-term benefits and carry significant risks, including addiction and overdose. Evidence for their effectiveness in improving function is scarce, especially for chronic back pain.

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Area of Science:

  • Pain Management
  • Pharmacology
  • Public Health

Background:

  • Back pain is a prevalent condition, frequently leading to healthcare visits and disability.
  • Opioid prescriptions for back pain have significantly increased in the US and Canada, making them the most prescribed drug class.
  • Opioid prescribing rates are notably higher in North America compared to Europe.

Purpose of the Study:

  • To evaluate the analgesic efficacy and functional outcomes of opioid use for acute and chronic back pain.
  • To assess the long-term effectiveness and safety of opioids, considering potential tolerance and hyperalgesia.
  • To review current strategies for mitigating opioid-related risks.

Main Methods:

  • Systematic reviews and analysis of randomized controlled trials (RCTs) for back pain.

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  • Examination of evidence from other acute pain conditions to infer efficacy for back pain.
  • Review of data on opioid prescribing trends, side effects, and mortality rates.

    • Main Results:

    • Opioids show limited efficacy for acute back pain, not expediting return to work or improving function.
    • Evidence for opioid efficacy in chronic back pain is scant, with short-term pain relief (around 30%) but unclear functional benefits.
    • Long-term effectiveness and safety remain unknown due to short trial durations and high dropout rates.
    • Opioid use is associated with significant short-term side effects (constipation, nausea, sedation) and long-term risks (addiction, overdose, depression).

    Conclusions:

    • Opioids provide minimal to moderate short-term pain relief for back pain but lack clear functional benefits.
    • The long-term risks of opioid use, including addiction and overdose, are substantial and may outweigh benefits.
    • Current risk mitigation strategies have not effectively reduced overall prescribing, misuse, or overdose rates.
    • Novel approaches focusing on selective prescribing, lower doses, and abuse-deterrent formulations are needed.