Are opioids a recommended treatment for low back pain?
Jon Ford, Clinical and Managing Director, Associate Professor of Physiotherapy, Fellow of the Australian College of Physiotherapists
Prescribing drugs of dependence for pain management is a complex (and sometimes controversial) topic, particularly when it comes to chronic pain.
A recent systematic review by Tucker H, et al 2020 (Harms and benefits of opioids for management of non-surgical acute and chronic low back pain: a systematic review. British Journal of Sports Medicine 2020;54:664) explored the consequences of prescription opioid use for people with low back pain (LBP). Commonly prescribed opioids include tramadol, tapentadol, oxycodone and codeine.
The paper’s primary aim was to evaluate the research on harms (such as stomach problems, addiction, tolerance and death) and benefits associated with opioids for acute and chronic back pain. An interesting secondary aim was to evaluate conflicts of interest in researchers studying opioids, which may have resulted in biased results.
The conclusion of this review paper was that in the short term, opioids were shown to be less effective than other medications (apart from placebo) and that opioids medication was associated with a higher rate of harms and more severe harms in most studies particularly for chronic LBP. Unfortunately, none of the trials evaluated opioids associated harms of long term use (> 12 weeks). In addition, the vast majority of trials (70%) that showed a benefit for opioids are influenced by conflicts of interest. There is currently no unified approach to opioid options in pain management.
What’s our approach to opioids in chronic pain management?
When we approach a pain management plan at Advance Healthcare, our focus is identifying when to initiate, continue or discontinue opioids based on potential harms and benefits. Often effective non-opioid options have not been considered and are worth trialling for individualised therapies. Overall our philosophy is that for many people with chronic pain, medication may only have a partial role and – in many cases – individualised physiotherapy and psychology coordinated with expert medical care provides the best outcomes.
With all treatment approaches (including medications), communicating the harms and benefits and tailoring an individualised approach is the key in restoring quality of life for people with chronic pain.
Please contact us to learn more about Advance Healthcare and the treatments we provide.
Associate Professor Jon Ford (PhD and titled Musculoskeletal and Pain Physiotherapist) is Group Leader of the Low Back Research Team at La Trobe University where he conducts clinical research on the effectiveness of individualised treatment for pain problems. He also the Clinical and Managing Director of Advance Healthcare where he leads a multi-disciplinary team working with chronic pain.