A new study calls for a medical rethink

A world-first trial led by the University of Sydney has found that opioids are no more effective than placebo for treating acute back and neck pain, and may even pose a risk of harm. The researchers believe that treatment guidelines should be updated to advise against the use of opioids for this type of pain.

The evidence calls for a change in treatment guidelines.

According to the world’s first trial led by the University of Sydney, opioids are no more effective than placebo for treating acute back and neck pain, and can even be harmful.

The research team believes that this evidence calls for updating treatment guidelines, and advises against the use of opioids for such cases. Which is concerning, given that more than 577 million people globally suffer from low back and neck pain at any given moment.

Despite global efforts to reduce opioid use, in Australia approx 40 to 70 Percent of those with neck and back complaints, opioids are prescribed to relieve their pain.

the Opal trial The researchers recruited approximately 350 participants from 157 primary care and emergency department sites. Participants with sudden, severe, short-term back or neck pain were randomly assigned to a six-week course of commonly prescribed opioids or a placebo.

Both groups also received standard care including advice to avoid bed rest and stay active. The participants were followed for 52 weeks.

The results of the experiment were recently published in scalpel.

What did the study find?

• And after six weeks, those who received the opioids had no better pain relief than those who took the placebo.
• Quality of life and pain outcomes at long-term follow-up were better in the placebo group.
• Patients who received opioids had a small but significantly higher risk of opioid misuse 12 months after a short course of treatment.

The research team says that according to Current guidelines for back and neck pain Opioids may be considered as a last resort if all other drug options fail, however, and this study is evidence that opioids should not be recommended at all.

“We have clearly shown that there is no benefit to prescribing opioids for the management of pain in people with acute back or neck pain and, in fact, can cause long-term harm even with only a short course of treatment,” said the team leader. Investigating Professor Christine Lane of Sydney Musculoskeletal Health, an initiative of Sydney Universityand the Sydney Local Health District and North Sydney Local Health District

Opioids should not be recommended for acute back and neck pain.

“Not even when other drug treatments could not be prescribed or were not effective for the patient.”

The study is complementary previous search In the use of opioids for chronic (long-term) low back pain that found a small therapeutic benefit, but increased risk of harm.

Global campaign to reduce opioid use

Reducing opioid overuse is a global health priority. Medical authorities around the world have warned that because of the significant risks to individuals and society, opioids should only be used when there is evidence that the benefits outweigh the harms.

Co-author Professor Chris Maher said in recent years There has been a shift In focus from opioid to non-opioid therapies for low back pain, with an emphasis on physical and psychological therapies and simple analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs).

Professor Maher, also one of the researchers, said: “This study is further evidence that first-line treatment for acute low back pain and neck pain should be based on reassurance, advice to stay active, and simple analgesics such as NSAIDs if needed.” Sydney Musculoskeletal Health.

Harm caused by opioid use

Professor Andrew MacLachlan, dean of the Sydney School of Pharmacy and co-author, said the Lancet study was important and should influence the prescribing and dispensing of these drugs as Australia faces increasing rates of opioid use.
According to the Australian Therapeutic Goods Administration, each day in Australia, there are approximately 150 hospital admissions and 14 emergency department admissions related to issues related to opioid use, and three people die from harm caused by the use of prescription opioids.

“The potential harmful effects of opioids are well known. They range from minor harms such as constipation and drowsiness to major harms such as dependence, addiction, overdose and even unintended death,” said Professor MacLachlan.

“The findings from the OPAL trial reinforce the need to re-evaluate the use of opioid medications for pain relief since there is limited evidence of benefit and known significant risks of harm.”

The authors noted some study limitations including data gaps due to participant attrition and problems with medication adherence consistent with trials of other back pain medications. They point out that neither is likely to influence the main findings of the study.

Reference: “Opioid Analgesia for Acute Low Back Pain and Neck Pain (OPAL Trial): A Randomized, Placebo-Controlled Trial” by Caitlin MB Jones, Richard O’Day, Bart W. Kwes, Gene Latimer, Chris G. Maher, Andrew J. MacLachlan, Laurent Pilot, and Sana Chan, and Zhong Wei Christine Lin, June 28, 2023, Available here. scalpel.
doi: 10.1016/S0140-6736(23)00404-X

The trial is a collaboration between the University of Sydney, the George Institute for Global Health, the University of New South Wales, St Vincent’s Hospital Sydney, the Sydney Local Health District and Erasmus University Medical Center in the Netherlands.

The study was funded by the National Health and Medical Research Council, SafeWorkSA and the University of Sydney School of Medicine and Health.