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Related Experiment Video

Updated: Nov 14, 2025

Biomechanical Changes Related to Low Back Pain: An Innovative Tool for Movement Pattern Assessment and Treatment Evaluation in Rehabilitation
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Opioids for chronic low back pain management: a Bayesian network meta-analysis.

Filippo Migliorini1, Nicola Maffulli2,3,4, Alice Baroncini1

  • 1Department of Orthopaedics and Trauma Surgery, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.

Expert Review of Clinical Pharmacology
|March 12, 2021
PubMed
Summary

For chronic low back pain (LBP), oxymorphone, tapentadol, and fentanyl demonstrated the highest efficacy among analyzed opioid therapies. Patient-specific factors and drug formulations are crucial for optimal treatment selection.

Keywords:
Spinechroniclow back painopiatespharmacologic treatment

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Area of Science:

  • Pain Management
  • Pharmacology
  • Clinical Research

Background:

  • Chronic low back pain (LBP) is a prevalent condition often necessitating opioid therapy.
  • Randomized clinical trials (RCTs) provide evidence for opioid efficacy in LBP management.

Purpose of the Study:

  • To conduct a Bayesian network meta-analysis (NMA) of RCTs evaluating opioid efficacy for chronic LBP.
  • To compare the effectiveness of various opioid medications in reducing LBP.

Main Methods:

  • Included RCTs comparing two or more opioids for chronic LBP, using the Numeric Rating Scale for pain assessment.
  • Analyzed fentanyl, morphine, tapentadol, oxycodone, buprenorphine, oxymorphone, and tramadol.
  • Utilized a Bayesian hierarchical random-effects model with standardized mean difference (SMD) for analysis.

Main Results:

  • Data from 2933 patients were analyzed, with a mean age of 53.30 years and symptom duration of 95.16 months.
  • Oxymorphone, tapentadol, and fentanyl exhibited the highest pain reduction efficacy.
  • Adverse event rates and drug formulations were also considered.

Conclusions:

  • Oxymorphone, tapentadol, and fentanyl are the most effective opioid options for chronic LBP based on current level I evidence.
  • Individual patient characteristics, drug formulations, and pharmacokinetics should guide treatment choices.