Opioids should not be recommended for acute non-specific low back pain or neck pain given that we found no significant difference in pain severity compared with placebo. This finding calls for a change in the frequent use of opioids for these conditions.
Jones et al. (2023)
Researchers in Sydney, Australia conducted a 6-year study and published their findings in The Lancet in July 2023. The study involved 347 participants in a triple-blinded, placebo-controlled randomized trial. After six weeks, both the control group and the opioid group (oxycodone–naloxone) completed a pain severity survey. The results showed that there was no significant difference in reported pain levels between the two groups at the six-week mark. However, the study revealed that the opioid group reported a greater number of adverse events during the course of the study.
These findings lead the researchers to recommend against the use of opioids as a treatment for acute low back pain. A sentiment shared by The American College of Physicians (ACP) who issued a clinical practice guideline for the treatment of low-back pain in 2017. The guideline advises health care providers and patients to use nondrug treatments as first-line therapy for chronic low-back pain. It also recommends the use of nondrug approaches for acute low-back pain.
So What “Nondrug Approaches” Did ACP Recommend?
Acute/Subacute back pain: massage, acupuncture, and spinal manipulation.
Chronic back pain: exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction, tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, and spinal manipulation.
Low back pain is one of the most common reasons for physician visits in the United States. According to the National Health Interview Survey most Americans have experienced low back pain, and approximately one quarter of US adults reported having low back pain lasting at least 1 day in the past 3 months. The recommendations by the American College of Physicians provide evidence-based solutions for addressing low back pain. Instead of simply masking the pain like medication, these options aim to address the underlying cause of the pain, especially when used in combination.
Jones CM, et al. Opioid analgesia for acute low back pain and neck pain (the OPAL trial): a randomized placebo-controlled trial. The Lancet. 2023 Jul 22;402(10398):304-12.
Qaseem A, et al. Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine. 2017 Feb 17; 166(7), 514.
Lamb Chiropractic CNY 