Opioids do not relieve acute non-specific pain in low back or neck: Lancet

The study, called OPAL (Opioid Analgesics for Pain in Acute Low Back Pain and Neck Pain), team have found that opioid analgesics provide no significant benefit in treating acute low back pain and neck pain.The findings were published in The Lancet.

OPAL was a triple-blinded, placebo-controlled randomized trial conducted in Sydney, Australia. It recruited adults aged 18 years or older with 12 weeks or less of low back pain or neck pain, or both, of at least moderate severity. The participants were randomly assigned to receive either guideline-recommended care plus an opioid analgesic (oxycodone-naloxone) or guideline-recommended care plus an identical placebo for up to 6 weeks.

The primary outcome measured was pain severity at 6 weeks using the pain severity subscale of the Brief Pain Inventory. The results showed that there was no significant difference in pain severity between the opioid group and the placebo group. The mean pain score at 6 weeks was 2.78 in the opioid group compared to 2.25 in the placebo group.

Furthermore, the study examined the safety profile of opioids in this context. Although there was no significant difference in overall adverse events between the two groups, more participants in the opioid group reported opioid-related adverse events, such as constipation.

These findings have significant implications for clinical practice. The study suggests that opioids should not be recommended as a first-line treatment for acute non-specific low back pain or neck pain. The lack of significant pain relief and the potential for opioid-related adverse events highlight the need for alternative treatment approaches.

The overreliance on opioids for these conditions has been a major concern due to the risk of addiction, dependency, and other serious side effects associated with their use. This study provides valuable evidence that challenges the prevailing practice of prescribing opioids for acute low back pain and neck pain.

Reference:

Jones, C. M. P., Day, R. O., Koes, B. W., Latimer, J., Maher, C. G., McLachlan, A. J., Billot, L., Shan, S., Lin, C.-W. C., McLachlan, H., Webb, M., Hamilton, M., Ahedi, H., Bompoint, S., Shan, S., … Yang, S. C. (2023). Opioid analgesia for acute low back pain and neck pain (the OPAL trial): a randomised placebo-controlled trial. In The Lancet. Elsevier BV. https://doi.org/10.1016/s0140-6736(23)00404-x