Landmark long-term study shows opioids no good for back pain

Got back pain? Think once, twice and then again before taking any opioid-based painkillers, warn international experts after the release of groundbreaking new research.

It found opioids were no better than ibuprofen or paracetamol at reducing lower back pain over a 12-month period, yet these opioids came with the threat of dependence and addiction, which has been blamed for an increase in accidental overdoses.

A long-term trial by Erin Krebs and the Minneapolis Veterans Health Care System studied 240 veterans taking opioids for chronic back and knee pain compared with those treated by non-opioids. The results were presented at a major medical conference in the US, but are yet to be published.

"The data do not support opioids' reputation as 'powerful painkillers'," Dr Krebs told the medical publication The Back Letter.

"The results support CDC [Centres for Disease Control and Prevention] guideline recommendation: that non-opioid medications are preferred for chronic pain."

They were also consistent with shorter studies that founds opioids to be no more effective than other groups of analgesics for lower back pain than anti-inflammatories or antidepressants, according to the Cochrane Review.

Back pain researcher James McAuley at Sydney's Neuroscience Research Australia (NeuRA) said Kreb's research was "important" and relevant to the almost 20 per cent of Australians with low back pain who were prescribed opioids,

Experts are looking for other ways to treat pain to reverse the explosion in the use of opioids, particularly to treat chronic pain. About 3 million Australians take opioids every year.



While exercise was recommended for most people with chronic back pain, it didn't lessen the pain, Dr McAuley said.

Now new research projects at NeuRA have found that changing the way that the brain deals with pain can make a big difference. These interventions, dubbed pain neuroscience, could also work to reduce other chronic pain. "The reason you have pain is that your brain has looked at all the evidence from your senses that there is danger to a certain part of your body. And if there is a threat, your brain produces pain so that you do something to remove the danger," Dr McAuley said.

Research by Dr McAuley and his colleague Sylvia Gustin found that the brains of people with chronic pain changed, with the areas that control emotions, such as the medial prefrontal cortex and the anterior insula, shrinking. "These brain changes increase the longer that someone has pain, but recently they have been shown to return to normal if pain goes away," he said.

They also found that people with acute back pain lack a chemical called Gaba, which calms the neurons in the brain. Gaba – gamma-Aminobutyric acid – reduces neuronal excitability throughout the nervous system.

To stop someone with back pain developing chronic problems, a pilot study at NeuRA by Dr McAuley and Dr Gustin found the use of a hypnotic used to help people sleep increased the Gaba.

They will soon launch a large randomised study in the hope this will prevent acute pain from becoming chronic.

It was the puzzle of phantom pain that prompted the new field of brain neuroscience, Dr McAuley said.

Another promising new study tried to turn down the "pain alarm" in people with chronic pain. In these cases, the brain's ability to locate the source of the pain had become inaccurate.

"If I was to touch you on the back, you couldn't tell whether I was touching you with a cotton wool bud or something sharp," he said of people with this kind of chronic pain.

By touching the backs of these people – and retraining the brain to identify different sensations – the brain's pain alarm was switched off, and sensitivity returned to individual areas, leading to less pain.Dr McAuley also recommended against back X-rays for anything other than very serious back pain. They only increased anxiety.

As for the American study, Stanford University Professor of Medicine Steven Asch responded by immediately tweeting: "Long-term opioids no better than Motrin for low back pain at 12 months. Just don't start them."

Asked if he had any advice for patients and physicians in the wake of this study, Asch told The Back Letter to use caution.

"Think twice before starting opiates in chronic musculoskeletal pain, then think again. They will work for a while, but this study says they don't do any better than Motrin or other [non-opioid drug] therapies in the long run."

He told The Back Letter that the study on opioids versus non-opioid treatment of back pain filled "a gaping hole in the literature". "Many have asked, 'Do opioids work for chronic musculoskeletal pain?' but until now, there have been few, if any, high-quality trials," he said.

"Now we know better. The best evidence argues against the use of chronic opiates for patients with long-term back or other musculoskeletal pain."


Source: http://www.smh.com.au/national/heal...ds-no-good-for-back-pain-20170803-gxop4z.html

Peer review on this will be interesting once the study is actually published.

the way the mainstream press reports on scientific matters is abysmal. they're framing this as though it is conclusively proven - and that oiates are completely ineffective. but that's not really what the study seems to be saying at all.
this is so obviously agenda-driven. this article's slant just seems like another push to take access to painkillers away from patients who need them, by claiming it will somehow "reverse the explosion in the use of opioids".

even if that's true, it's hardly 'news' IMO

^precisely my thoughts. It is indeed frustrating, and it seems like it's gotten worse since the emergence of social media platforms like Twitter

I was just pointing how someone made this mistake from research they found on the efficacy of buprenorphine vs methadone over in SL. Folks are so quickly to misunderstand the nature of peer reviewed journals and the empirical sciences.

Poor science

yep, and the mainstream press are all too quick to publish preliminary findings as some overarching "truth".

i thought it was pretty well understood that opioid painkillers aren't an effective treatment for chronic pain, and that musculoskeletal pain. this only serves to increase ignorant assumptions in the community and increase the stigma of painkillers, which isn't going to help anyone.

i know people who need strong painkillers to help them deal with their crippling pain, and it's already hard enough for them to get the prescriptions they need.

the only agenda this sort of lazy journalism serves is to make life harder for legitimate pain patients imho.
i sees it as irresponsible journalism - which is all in a day's work for the sydney morning herald

There are tons of published scientific papers showing opiates work for long term back pain.


and if they aren't prescribed those with back pain will seek heroin, not look at conflicting scientific papers and decide not to do heroin.

I will say after just coming offa surgery, ( not on my back) after weeks on opiates an tolerance built I found alot of relief in taking 600mg ibuprofen 3/4 times daily.

But after weeks of motrin and Tylenol use I was gettin such bad side effects and could not in any way take them for 12 months.

Not to mention the work it was probably doing on my kidneys and digestive system.

It is pretty cool that 600-800mg IBU is more effective than 5/500mg of hydrocodone/APAP for quite a few types of pain.

not to mention the "minneapolis verterans healthcare" or whatever isn't exactly Harvard medical school putting out such a study....let see if it even makes it into a top medical journal or just some publication mill with shitty ratings.

hardly looks like a landmark study at face value. Also with hysteria due to fentanyl ODs among heroin users, pain patients are in the crosshairs and being blamed, so do you think government funding for a research group saying that long term opiates are effective for low back pain would be strong? no.


once again, we are blaming and punishing sick people for the failure of the DEA to prevent heroin and fent from flooding into the US. When will a study come out saying that opiates are not effective for cancer pain? Not soon because we for some reasons feel sorry enough for cancer patients to let them have opiates with out taking them away because peeople mainlining heroin and RCS keep dying.

Yeah just read some shit about how they are suing Purdue teva endo and j&j for prescribed opiates.