A carefully conducted study of treatments for short-term back pain finds that opioids aren’t the best approach. The results throw into question current guidelines.
MARY LOUISE KELLY, HOST:
Lower back pain is a familiar complaint in doctors’ offices around the country. Physicians sometimes prescribe opioids for short-term pain relief, but new research questions whether that is actually the best approach. NPR’s Will Stone reports.
WILL STONE, BYLINE: Much of the low back pain that drives Americans to see the doctor is considered nonspecific, meaning it’s not clear why it’s happening. And it usually doesn’t last that long.
ANDREW MCLACHLAN: There are many causes of acute onset lower back pain. It could be about a twist, an injury, a lift.
STONE: That’s Andrew McLachlan, dean of pharmacy at the Sydney Pharmacy School in Australia.
MCLACHLAN: You can’t really take an X-ray from someone who has nonspecific lower back pain and say, this is the problem.
STONE: Medical guidelines for this kind of back pain generally recommend that doctors take a conservative approach, maybe start with anti-inflammatories or simply heat and exercise. If nothing is helping, though, doctors can prescribe a short course of opioids. McLaughlin says prior research has focused on whether opioids help for chronic back pain, which lasts longer than three months.
MCLACHLAN: So we really wanted to target and investigate people who had an onset in recent weeks of a lower back pain episode.
STONE: They recruited about 350 patients with this garden-variety low back or neck pain and then split them into two groups. One received a placebo; the other, oxycodone.
MCLACHLAN: What we found after six weeks, which was our major focus, was that the pain relief was no different between people who got a strong pain relieving medicine – oxycodone – or a placebo, which was quite a surprise to us.
STONE: They also found through surveys that those in the opioid group had an elevated risk of opioid misuse a year later. The findings were published in the Lancet Medical Journal on Wednesday. Richard Deyo is an emeritus professor at Oregon Health and Science University and an expert on low back pain.
RICHARD DEYO: It’s going to ruffle feathers, and I think there’ll be a lot of controversy.
STONE: Opioid prescribing in the U.S. has fallen substantially for more than a decade, given the well-known risks of addiction and overdose. Dr. Samer Narouze expects this will be a landmark study, but he worries that its top line results may get misconstrued.
SAMER NAROUZE: I’m concerned that this study will be used or weaponized to deny patients with acute pain from the needed opioids. Definitely, opioids are indicated for moderate to severe acute pain that’s not controlled with others.
STONE: Narouze is chair at the Center for Pain Medicine at Western Reserve Hospital in Ohio. The patients in this study did not have serious spinal pathology – that is, things like fractures, infections or some underlying illness or emergency. That was by design. But Narouze says the findings should not be applied to these types of patients. He also points out the specific opioid used in the study is not really representative of how acute pain is handled.
NAROUZE: The regimen that they used – the opioid was really unorthodox, at least in the States. We do not treat acute pain with long-acting opioids.
STONE: That’s because the point is to use short-acting opioids so that when people are in pain, they can take the medication as needed and it works quickly. Dr. Mark Bicket directs research on opioids and pain at the University of Michigan. He believes this study will call into question some of the current medical guidelines on how to handle common low back pain.
MARK BICKET: This one study won’t rewrite the guidelines entirely. I think it will motivate many future studies to be done both for back pain as well as for other conditions.
STONE: And he says it’s a reminder that doctors should try to emphasize other treatments than opioids to start. Will Stone, NPR News.
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