Can Opioids help manage back pain?

 

Back pain is a common issue that spans many physiological locations and demographics. Its exact cause is unknown, though there are likely many contributing factors. It is infrequently debilitating, but still poses a serious problem for those that suffer from it. Opioid prescriptions for back pain are increasingly common, contributing to the overabundance of opioids in American society.

 

 

The efficacy of opioids in treating back pain is questionable. Some studies show opioids provide short-term pain relief for back pain. One review found opioids increase functionality in back pain patients, however the claim is backed by weak evidence.

 

 

One study found that after twelve months of opioid use, patients with lower back and knee pain reported no significant increase in functionality compared with the control group. Additionally, it found pain intensity to be less severe in the group without opioids after 12 months while the opioid group experienced more negative side effects after the same time.

 

 

Long term opioid use is dangerous. The drugs can cause an array of negative health side effects including sedation, dizziness, nausea, vomiting, constipation, and respiratory depression. These side effects can be difficult to live with and may be more severe than the initial back pain itself.

 

Addiction or physical dependence is another destructive side effect. One theory suggests that while taking opioids, some people become hypersensitive to specific types of pain, instead of becoming desensitized to it. This is called a ‘drug opposite’ response and can contribute to addiction. Increasing the dose of the drug consumed, may lessen the pain or disturbances caused by the ‘drug opposite’ response, thereby starting a malicious cycle of over-consuming opioids to escape the ‘drug opposite’ response and increasing drug dependency

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The most serious consequence of opioid use can be death. Within the past few decades, opioid related deaths have become an epidemic in the United States. The number of opioid related deaths exceeds that of suicides and car related deaths as well as the deaths caused by other drugs such as cocaine and heroin. About 60% of these deaths stem from doctor prescribed opioids, with 20% being low dose prescriptions.

 

Given the host of potential problems that may arise from opioid use, alternative methods for controlling back pain should be considered. Non-steroidal anti-inflammatory drugs or acetaminophen may be sufficient. Drugless options include “acupuncture, exercise therapy, multidisciplinary rehabilitation programs, massage, behavior therapy, and spinal manipulation”.

 

A recent study conducted on patients with chronic low back pain found meditation and cognitive behavioral therapy practiced for 30 min a day, six times a week, to be effective at lessening pain and thermal sensitivity. It also identified a possible relationship between time spent meditating and degree of pain reduction, hinting that this method can work for patients across the spectrum of lower back pain, from slight to severe.

 

Poor evidence and potentially disastrous consequences should make people reconsider opioid use to treat back pain. There is a plethora of other options available that may be equally or more effective at reducing pain.

 

Sources:

  1. Benyamin, R., Trescot, A. M., Datta, S., Buenaventura, R., Adlaka, R., Sehgal, N., Glaser, S. E., & Vallejo, R. (2008). Opioid complications and side effects. Pain physician, 11(2 Suppl), S105–S120.
  2. Chaparro LE, Furlan AD, Deshpande A, Mailis‐Gagnon A, Atlas S, Turk DC. Opioids compared to placebo or other treatments for chronic low‐back pain. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD004959. DOI: 10.1002/14651858.CD004959.pub4. Accessed 25 October 2021.
  3. Deyo R A, Von Korff M, Duhrkoop D. Opioids for low back pain BMJ 2015; 350 :g6380 doi:10.1136/bmj.g6380
  4. Krebs, E. E., Gravely, A., Nugent, S., Jensen, A. C., DeRonne, B., Goldsmith, E. S., Kroenke, K., Bair, M. J., & Noorbaloochi, S. (2018). Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain: The SPACE Randomized Clinical Trial. JAMA, 319(9), 872–882. https://doi.org/10.1001/jama.2018.0899
  5. Last, A. R., & Hulbert, K. (2009). Chronic low back pain: evaluation and management. American family physician, 79(12), 1067–1074.
  6. Manchikanti L, Helm S 2nd, Fellows B, et al. Opioid epidemic in the United States. Pain Physician. 2012 Jul;15(3 Suppl):ES9-38. PMID: 22786464.
  7. Nachemson AL. Advances in low-back pain. Clinical Orthopaedics and Related Research. 1985 Nov(200):266-278. PMID: 2933201.
  8. White J. M. (2004). Pleasure into pain: the consequences of long-term opioid use. Addictive behaviors, 29(7), 1311–1324. https://doi.org/10.1016/j.addbeh.2004.06.007

Zgierska, A. E., Burzinski, C. A., Cox, J., Kloke, J., Stegner, A., Cook, D. B., Singles, J., Mirgain, S., Coe, C. L., & Bačkonja, M. (2016). Mindfulness Meditation and Cognitive Behavioral Therapy Intervention Reduces Pain Severity and Sensitivity in Opioid-Treated Chronic Low Back Pain: Pilot Findings from a Randomized Controlled Trial. Pain medicine (Malden, Mass.), 17(10), 1865–1881. https://doi.org/10.109

 

 

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