The results show that there is no effect of opioids either in the short or long term – on the contrary.
Overall, opioid consumption in Denmark is falling, primarily because the consumption of tramadol has halved. However, the number of Danes who are prescribed other forms of opioids is increasing1. Opioids are often prescribed to patients who consult their GP or the emergency room with severe acute back or neck pain. Researchers from Australia have investigated the effect of opioids compared to placebo pills in the treatment of acute moderate to severe pain (< 12 weeks) in the lumbar spine and neck2.
347 participants recruited from GPs or emergency departments with either acute back or neck pain were randomized to receive either 5 mg oxycodone twice daily with increasing dose to 10 mg daily for 6 weeks or until pain resolution (0 or 1 in 10) or placebo pills with the same appearance. The primary endpoint was pain intensity measured after 2, 4, 6, 12, 26, and 52 weeks. After 2, 4, 6, 12, and 26 weeks, there was no statistically significant difference between the groups, although there was a tendency for the placebo group to report less pain. After 52 weeks, there was a statistically significant difference between the groups such that the placebo group reported the least pain. There was no statistical difference in the number of side effects between the groups, although most in the opioid group reported side effects, 127 cases in 61 patients in the opioid group versus 91 cases in 51 participants in the placebo group. The most frequent side effects were vomiting, constipation, headache, dizziness and sleepiness. Furthermore, the authors found that in the opioid group after 52 there were statistically significantly more people who showed symptoms of addiction even though the treatment in the study was completed after 6 weeks.
The authors conclude that short-term use of opioids does not benefit patients with acute back and neck pain either immediately or over time. On the contrary, it causes more side effects and an increased risk of abuse in the long term.
This is the first placebo-controlled study investigating the effect of opioids on acute nonspecific back and neck pain. Thus, there is now no evidence that opioids should be prescribed for this patient group, quite the opposite. The results of the study should be communicated by relevant health authorities and regions in Denmark to general practitioners and emergency rooms so that prescriptions for these conditions can stop. There are good alternatives to opioids that are both effective and safe.
- Danish Health Authorities, 2023. https://sundhedsdatastyrelsen.dk/-/media/sds/filer/find-tal-og-analyser/laegemidler/smertestillende-medicin/forbrug_af_opioider_2021.pdf?la=da
- Jones CMP et al. Opioid analgesia for acute low back and neck pain (the OPAL trial): a randomized placebo-controlled trial. Lancet 2023;402:304-12 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00404-X/fulltext
