Thinking of taking opioids for low back pain? Here's what you need to know

December 5, 2017 by Christine Lin, Christina Abdel Shaheed And Stephanie Mathieson, The Conversation
When it comes to treating low back pain, opioids have many risks and few benefits. Credit: Shutterstock

Low back pain is a common problem affecting more than 80% of us at some point in our lives. Recommended treatments include staying active and, if possible, avoiding strong pain medicines such as opioids.

Despite this, opioids (such as oxycodone) and combination medicines (such as paracetamol plus codeine) are the most commonly prescribed drugs for low back in Australia. The most recent analysis showed that 45.6% of all pain medicines GPs recommended for low back and in 2013/2014 were opioids, up from 40.2% in 2005/2006.

Our research, published this week in the journal Medicine Today, shows opioids should only be considered in limited circumstances for and greater efforts are needed to help people come off opioids.

Benefits of opioids

A 2016 review of the research found commonly prescribed doses of opioids provided a small amount of pain relief for people with chronic low back pain in the short term. But higher doses did not meaningfully improve pain levels.

Opioid drugs work by interacting with opioid receptors in the body. This triggers a cascade of effects, including reducing the release of neurotransmitters ("chemical messengers") that send pain information to the brain.

Ongoing benefits of opioid pain relievers are not known, as there are no clinical trials reporting long-term data. Observational studies show long-term opioid use has uncertain benefits for pain levels, while increasing harms.

The specific effects of opioids in patients with acute low back pain (pain lasting less than three months) are also not known, as there have been no clinical trials conducted in this population.

Harms of opioids

The risk of unwanted effects with opioids is high. These include constipation, dizziness and nausea.

There are also risks of more serious harms, such as dependency which results in withdrawal symptoms when the medicine is stopped. These include anxiety, nausea, restlessness, sweating, vomiting or abdominal pain, and make it hard to stop taking opioids.

Other serious harms include opioid overdose and death. About 62 people die each day in the United States from prescription opioid overdoses. In Australia, there has been a rise in opioid-related deaths in recent years alongside an increase in opioid prescribing.

Short-term back pain

Acute low back pain is rarely the result of a serious condition and will generally resolve quickly with time. It's important to maintain regular activity and avoid bed rest. You can also try a heat pack for pain relief and may not need other treatments.

If medicines are required for , consult a doctor or pharmacist about appropriate drug choices. This may involve short-term use of simple pain medicines such as paracetamol or a non-steroidal anti-inflammatory medicine such as ibuprofen.

Opioids should only be considered if the pain is severe, other treatments have not worked and the benefits outweigh the harms. Your doctor will assess whether you are a suitable candidate and guide you through the process.

If opioids are recommended, use them for the shortest time possible, at the lowest effective dose, in conjunction with other non-drug treatments, such as staying active. Opioid use should stop after the pre-agreed treatment period. You should inform your doctor of any unwanted effects while on the medicine.

Chronic back pain

Low back pain lasting longer than three months is more complex so it's important not to rely solely on drug treatments to get better. Start with non-drug treatments such as exercise and physiotherapy.

Sometimes you may need the expertise of multiple health professionals, such as GPs, allied health professionals and medical specialists, as there may be many contributing factors to your pain. Some programs combine exercise with psychological approaches such as cognitive behavioural therapy, which is designed to change unhealthy habits of feeling, thinking or behaving.

If pain medicines are required, follow the same principles as for acute low back pain. If opioids are required, you should have a clear plan to wean and cease the opioid, especially if there's no improvement in pain.

Coming off opioids

Consider coming off opioids if:

  • there has not been any meaningful improvement in pain and function within a few days of starting the , even with increased doses
  • you have unwanted side effects
  • you notice early warning signs for overdose risk such as confusion, slurred speech, or work/family problems related to opioid use.

If you have been taking an opioid for some time, it may not be a good idea to stop the medicines suddenly due to potential withdrawal effects. Your doctor can help you to come off the medicines gradually, as well as arrange referrals to other support services if needed.

Long-term care plans may involve opioid substitution programs such as the methadone program, which aim to stabilise the dependency. These programs are offered in some community pharmacies and hospitals. Your doctor will usually be able to coordinate a care pathway suitable for you.

The journey toward stopping these medicines is challenging, but not impossible. Be assured many people experience improved function, without worsening pain while coming off opioids.

Explore further: Drugstore pain pills as effective as opioids in ER patients

Related Stories

Drugstore pain pills as effective as opioids in ER patients

November 7, 2017
Emergency rooms are where many patients are first introduced to powerful opioid painkillers, but what if doctors offered over-the-counter pills instead? A new study tested that approach on patients with broken bones and sprains ...

Long-term opioid use does not increase risk of Alzheimer 's disease

October 24, 2017
Opioid use is not associated with an increased risk of Alzheimer's disease, shows a recent study from the University of Eastern Finland. Researchers did not find any risk neither for long-term use nor for higher cumulative ...

When is an opioid safe to take?

June 26, 2017
(HealthDay)—Many people in pain are apprehensive about taking an opioid painkiller to ease their suffering, and rightfully so.

Depressed patients more likely to be prescribed opioids

June 20, 2017
A new study shows that patients with low back pain who were depressed were more likely to be prescribed opioids and receive higher doses. Understanding these prescribing patterns sheds new light on the current opioid epidemic ...

Evidence-based approach to treating post-delivery pain in new moms during opioid crisis

November 14, 2017
Women who undergo vaginal delivery often do not require opioids to manage pain after hospital discharge, concludes a study published in Anesthesiology, the peer-reviewed medical journal of the American Society of Anesthesiologists ...

Day-supply of opioid Rx factor in likelihood of long-term use

August 24, 2017
(HealthDay)—The days supplied is far more important than the dosage level or even the type of pain being treated in risk of opioid use disorder following opioid prescription, according to a study published recently in The ...

Recommended for you

Discovery opens door for synthetic opioids with less addictive qualities

June 1, 2018
Making opioids from sugar instead of from field grown opium poppies has the potential to solve many of the problems associated with manufacturing strong pain killers.

US doctors prescribing fewer opioid painkillers: report

May 31, 2018
US doctors reduced the number of prescriptions for opioid painkillers last year, continuing a five-year trend, in an effort to reverse a deadly drug abuse epidemic, a report released Thursday said.

Researchers publish study on new therapy to treat opioid use disorder

May 22, 2018
Better delivery of medications to treat opioid use disorder (OUD) is key to addressing the opioid crisis and helping the 2.6 million Americans affected by the disease.

Could nonprofit drug companies cut sky-high prices?

May 17, 2018
(HealthDay)—Generic prescription drugs should be cheap, but prices for some have soared in the United States in recent years. Now a group of U.S. hospitals thinks it has a solution: a nonprofit drug maker.

Fewer antibiotics for kids, but more ADHD drugs

May 15, 2018
(HealthDay)—American kids are taking fewer prescription medications these days—but certain drugs are being prescribed more than ever, a new government study finds.

Opioid makers' perks to docs tied to more prescriptions

May 14, 2018
Doctors who accept perks from companies that make opioid painkillers are more likely to prescribe the drugs for their patients, new research suggests.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.