What?
In a medical world dominated by quick fixes and potent prescriptions, a recent study has suggested a turn of tide for a common condition – acute low back and neck pain. Opioids, one of the most frequently prescribed medicines for these conditions, have been put under the microscope, and the findings might not be what you’d expect.
Researchers from the University of Sydney conducted a randomised controlled trial, the gold standard of scientific research, where they tested the efficacy and safety of short-term opioid treatment for acute non-specific low back and neck pain.
The OPAL study, recently published in The Lancet, included 347 adults who had been experiencing pain for 12 weeks or less (Jones et al, 2023).
The results? In short, opioids did not prove superior to placebo (a harmless sugar pill) in relieving the pain. In fact, those who took opioids were at a greater risk of developing opioid misuse after a year.
Why?
This ground-breaking trial brings a significant shift in our understanding of pain management. Despite being frequently prescribed, there wasn’t substantial evidence before this trial to show whether opioids were effective for acute low back pain or neck pain.
But why are opioids prescribed so readily? It’s due to the immense pain-relieving power opioids carry. They work by attaching to specific proteins called opioid receptors, which are found in the brain, spinal cord, and gastrointestinal tract. When these drugs attach to their receptors, they reduce the perception of pain.
However, opioids also have the potential to lead to misuse and addiction, causing widespread concern. Hence, it’s of utmost importance that the benefits of these potent drugs are weighed against their potential risks. The OPAL trial conducted in Australia did just that and found that the balance might not be in favour of opioids when it comes to treating acute back and neck pain.
How (does it affect you)?
For patients struggling with acute low back and neck pain, these results bring hope for safer and more effective pain management strategies. It signals a move away from a dependence on potent opioids and towards a more sustainable approach to pain management. Currently in the NHS, opioids are an accepted last resort for back pain, though this new research, may change NICE guidance on prescribing.
The paper does have some severe pitfalls however. The drug used was oxycodone, which while an opioid itself, does not represent the full spectrum of opioid medications including tramadol and morphine, and newer generation drugs like tapentadol. The researchers effectively rule out opioids for any type of back pain, but their findings based on only one type of opioid.
For some people, a short course of opioid medication is the only effective remedy, once maximum doses of standard over the counter medications have been used without achieving adequate pain relief. Regardless, the findings of the paper are set to change the prescribing landscape in back pain. Indeed, this may well result in fewer patients unnecessarily experiencing opioid side effects, given most cases will self resolve in 6 weeks with exercise and appropriate use of over-the-counter painkillers.
However, for a small population of back pain sufferers where pain is resistant to standard painkillers and/or lasts over 3 months, opioids may still represent an appropriate treatment when prescribed by a specialist pain medicine doctor. There is a concern that this smaller patient group is at risk of discrimination based on their pain needs, and in turn may be underserved by doctors without a specialist knowledge of pain medicine.
In light of these findings, it’s important for you to discuss all treatment options with your doctor. In the UK, for example, the National Health Service (NHS) recommends trying physical therapies before considering medications for low back pain. Staying active, avoiding bed rest, using heat packs for temporary relief, and, if necessary, considering non-opioid drugs like anti-inflammatory medications, are all strategies that may help.
Accessing these services via the NHS is a matter of getting a referral from your GP. Should you need physiotherapy, your GP, or another healthcare professional, can provide you with the necessary referral. In some areas, you can also refer yourself for NHS physiotherapy – this may be called a ‘first contact’ musculoskeletal (MSK) physio; see your GPs’ website.
These recent findings do remind us that the quickest fix isn’t always the best one. For acute low back and neck pain, the move away from opioids may bring promises of safer and more effective treatment options, allowing you to recover and get back to your normal routine as swiftly and safely as possible. On the other hand, a small group of patients may lose access to a medication of last resort. Watch this space.
As always, best wishes from myHSN!
