Healthcare professionals should not recommend opioids for non-specific, acute, low back or neck pain, say Australian researchers in The Lancet.

The researchers compared 174 and 173 adults (mean age 44.7 years) receiving opioids and placebo respectively for low back pain, neck pain, or both. Of these, 49 per cent were female and 97 per cent were recruited in primary care. 

Opioid users took 5mg oxycodone and 2.5mg naloxone modified-release tablets twice daily. The dose was titrated to a maximum of 10mg twice daily. Treatment continued for up to six weeks, by which time 19 and 15 per cent of opioid and placebo users respectively had discontinued. 

Mean pain scores at six weeks did not differ significantly between remaining opioid and placebo users. The difference in pain scores increased over time until week 52, when “a small but significant difference” favoured placebo over opioids. 

More opioid users were at risk of medication misuse at week 52 than with placebo (20 and 10 per cent respectively).

Moreover, 35 and 30 per cent of the opioid and placebo group respectively reported at least one adverse event. Not surprisingly, those taking opioids were more likely than placebo users to report certain adverse events such as constipation. Opioid users had worse quality-of-life mental health scores at weeks six and 12 than the placebo group.

Opioids “could be making patients’ pain levels worse in the medium and long-term”, says senior author Professor Christine Lin, University of Sydney. She adds that even short opioid courses increase the risk of misuse long-term. 

“Considering all the evidence and known risks, we firmly believe doctors should not prescribe opioid pain relievers for new episodes of lower back and neck pain,” Professor Lin adds. “Instead, doctors should…focus on patient-centred approaches that could include advice to stay active and simple pain relievers. The good news is most people with acute low back pain and neck pain recover within six weeks naturally.”