“There’s no uncertainty here. There’s simply no reason to prescribe opioids for acute back pain.”
Loading
Opioids areestablishedas effective painkillers,but there are few direct studies of opioids for back pain;existing studies are either poor-quality or funded by opioid manufacturers.
Doctors have just assumed because the drugs work for post-surgical pain they will work for other pains,said Professor Christine Lin,a back pain researcher at the University of Sydney and senior author of the study.
But back pain is not like post-surgical pain:for nearly all people,it will improve by itself over time.
There are concerns - speculative at this point - that opioids may actually slow recovery,Lin said,because they can leave people foggy,lethargic,and less likely to return to work or exercise.
Indeed,almost a year after the study ended the patients given opioids were still doing worse than those given a placebo.
“We believe these results should change the guidelines,because they are very definitive – no short-term benefits,and long-term harms,” Lin said.
Professor Rachelle Buchbinder,co-ordinating editor ofCochrane Musculoskeletal,Back and Neckwho worked on the taskforce that developed the Australian government’slow-back pain clinical care standards,agreed with Lin’s assessment.
“And it probably applies to back pain,to knee pain,to neck pain,to shoulder pain,” she said.
Loading
But the Faculty of Pain Medicine at the Australian and New Zealand College of Anaesthetists – also represented on the taskforce – pushed back on that claim.
A spokeswoman pointed out the study tested slow-release opioids,rather than those that give fast relief as recommended by the guidelines.
“The faculty is concerned about the robustness of the randomised placebo-controlled trial study particularly given the study’s findings are based on a modified release opioid for acute pain which is an ‘off-label’ use of such medications and therefore not approved,” the spokeswoman said.
Stonemason Peter Ritchie ruptured a pair of discs in his spine in a workplace accident a few years ago. His doctor immediately put him on the opioid Endone.
“I did not like how they made me feel – I was really foggy,” Ritchie said. “The pain was still there,but it was sort of masking it.”
Ritchie was told he’d need a spinal fusion and would probably be on opioids for life. “I was just like,‘Nah,I’ve gotta find something better than this’,” he said.
Instead,Ritchie turned to physiotherapy,massage and healthy eating,weaning himself off the drugs. Three months after the accident,he was largely pain free. Friends who have had the surgery,he said,are still in pain.
“I think I took the better avenue.”