HOMEPRODUCTSSERVICESCOMPANYCONTACTFAQResearchDictionaryPharmaMobileSign Up FREE or Login

Opioids for low back pain.

Abstract
Back pain affects most adults, causes disability for some, and is a common reason for seeking healthcare. In the United States, opioid prescription for low back pain has increased, and opioids are now the most commonly prescribed drug class. More than half of regular opioid users report back pain. Rates of opioid prescribing in the US and Canada are two to three times higher than in most European countries. The analgesic efficacy of opioids for acute back pain is inferred from evidence in other acute pain conditions. Opioids do not seem to expedite return to work in injured workers or improve functional outcomes of acute back pain in primary care. For chronic back pain, systematic reviews find scant evidence of efficacy. Randomized controlled trials have high dropout rates, brief duration (four months or less), and highly selected patients. Opioids seem to have short term analgesic efficacy for chronic back pain, but benefits for function are less clear. The magnitude of pain relief across chronic non-cancer pain conditions is about 30%. Given the brevity of randomized controlled trials, the long term effectiveness and safety of opioids are unknown. Loss of long term efficacy could result from drug tolerance and emergence of hyperalgesia. Complications of opioid use include addiction and overdose related mortality, which have risen in parallel with prescription rates. Common short term side effects are constipation, nausea, sedation, and increased risk of falls and fractures. Longer term side effects may include depression and sexual dysfunction. Screening for high risk patients, treatment agreements, and urine testing have not reduced overall rates of opioid prescribing, misuse, or overdose. Newer strategies for reducing risks include more selective prescription of opioids and lower doses; use of prescription monitoring programs; avoidance of co-prescription with sedative hypnotics; and reformulations that make drugs more difficult to snort, smoke, or inject.
AuthorsRichard A Deyo, Michael Von Korff, David Duhrkoop
JournalBMJ (Clinical research ed.) (BMJ) Vol. 350 Pg. g6380 ( 2015) ISSN: 1756-1833 [Electronic] England
PMID25561513 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)
Copyright© BMJ Publishing Group Ltd 2015.
Chemical References
  • Analgesics, Opioid
  • Hypnotics and Sedatives
Topics
  • Analgesics, Opioid (therapeutic use)
  • Chronic Pain (drug therapy, epidemiology)
  • Disability Evaluation
  • Evidence-Based Medicine
  • Humans
  • Hypnotics and Sedatives (contraindications)
  • Low Back Pain (drug therapy, epidemiology)
  • Opioid-Related Disorders (epidemiology)
  • Practice Patterns, Physicians'
  • Prevalence
  • Randomized Controlled Trials as Topic
  • United States

Join CureHunter, for free Research Interface BASIC access!

Take advantage of free CureHunter research engine access to explore the best drug and treatment options for any disease. Find out why thousands of doctors, pharma researchers and patient activists around the world use CureHunter every day.
Realize the full power of the drug-disease research network!


Choose Username:
Email:
Password:
Verify Password: