Rethinking the Efficacy of Opioids for Acute Back and Neck Pain: Groundbreaking Study Advocates for Updated Treatment Guidelines

A pioneering clinical trial spearheaded by the University of Sydney has revealed that opioids do not surpass placebos in effectiveness for treating acute back and neck pain. Moreover, they may present a danger for adverse outcomes. The research team contends that these findings necessitate revisions to current medical guidelines to discourage the prescription of opioids for such conditions.

The study underscores the imperative for altering existing treatment protocols.

Conducted as the world’s first of its kind by the University of Sydney, the trial concluded that opioids offer no advantages over a placebo in the treatment of acute back and neck pain and may even pose a risk. Given that more than 577 million people worldwide are dealing with low back and neck pain at any point in time, the implications are considerable.

In spite of a global effort to decrease opioid use, in Australia, a range between 40 to 70 percent of individuals presenting with back and neck issues are prescribed opioids to manage their discomfort.

The OPAL study engaged nearly 350 participants from 157 primary healthcare and emergency department locations. Those experiencing acute—that is, sudden and typically short-lived—back or neck pain were randomly assigned to a six-week regimen of either a commonly used opioid or a placebo. Standard care, including recommendations to remain active and avoid bed rest, was also provided to both groups. The participants were monitored for a duration of 52 weeks.

The Lancet recently published the study’s outcomes.

Study Conclusions

• At the end of the six-week period, opioid recipients did not experience superior pain relief compared to the placebo group.
• Long-term follow-up indicated better quality of life and pain results in the placebo cohort.
• There was a small yet significant increase in the risk of opioid misuse in patients who had been on a brief opioid regimen after 12 months.

According to the prevailing guidelines for back and neck pain, opioids may be considered a last-ditch option when all other pharmacological treatments have been exhausted. However, this research provides compelling evidence that opioids should not be endorsed at all for these conditions.

Lead researcher Professor Christine Lin from Sydney Musculoskeletal Health—an initiative comprising the University of Sydney, Sydney Local Health District, and Northern Sydney Local Health District—stated, “The study provides unequivocal evidence that opioids should not be part of the treatment protocol for acute back or neck pain, as it could lead to detrimental long-term consequences, even following a short treatment duration.”

The study aligns with previous research on the use of opioids for chronic (long-term) low back pain, which found a minor treatment advantage but a heightened risk for negative effects.

A Global Call for Opioid Reduction

There is a worldwide consensus among healthcare authorities that minimizing opioid misuse is paramount. The focus has been shifting toward non-opioid treatments, involving physical and psychological therapies along with basic analgesics like non-steroidal anti-inflammatory drugs (NSAIDs).

Co-author Professor Chris Maher emphasized, “The evidence further confirms that initial management of acute low back and neck pain should prioritize reassurance, advice to stay active, and the use of NSAIDs when needed.”

The Detrimental Impact of Opioid Usage

Professor Andrew McLachlan, Dean of Sydney Pharmacy School, asserted that this significant study should inform prescription habits, particularly given Australia’s rising rates of opioid consumption. On an average day in Australia, nearly 150 hospitalizations and 14 emergency room visits relate to opioid issues, and three lives are lost due to prescription opioid misuse.

Potential adverse effects of opioids range from minor issues such as constipation and drowsiness to serious problems including dependence, addiction, overdose, and unintentional death.

The OPAL trial’s outcomes further fortify the call to re-evaluate the employment of opioid analgesics, given the scant evidence of their benefits and the well-established risks they pose.

The researchers noted some limitations of the study, including attrition and issues related to medication adherence, which are consistent with other trials on back pain medication. They argue that these limitations are unlikely to have influenced the principal conclusions of the study.

Reference

The study, titled “Opioid analgesia for acute low back pain and neck pain (the OPAL trial): a randomised placebo-controlled trial,” was published in The Lancet on June 28, 2023.

The collaborative effort involved the University of Sydney, The George Institute for Global Health, UNSW, St Vincent’s Hospital Sydney, Sydney Local Health District, and Erasmus University Medical Center in the Netherlands. Funding was provided by the National Health and Medical Research Council, SafeWorkSA, and the Faculty of Medicine and Health, University of Sydney.

Frequently Asked Questions (FAQs) about Opioids and Acute Back and Neck Pain Study

More about Opioids and Acute Back and Neck Pain Study

• University of Sydney Research Programs
• The Lancet Medical Journal
• National Health and Medical Research Council Funding
• SafeWorkSA Website
• Sydney Musculoskeletal Health Initiative
• Australia’s Therapeutic Goods Administration
• Global Health Priorities on Opioid Use
• Erasmus University Medical Center Research
• UNSW Research Collaborations
• St Vincent’s Hospital Sydney Research
• Faculty of Medicine and Health, University of Sydney