Opioid use: less is better for back pain?
Take Home Messages:
Opiates such as slow release morphine, OxyContin or Endone, are being used more commonly to treat pain.
Early use of high doses of opiates in patients with low back pain is associated with poor long-term outcomes. They are more likely to have prolonged disability, increased need for surgery, and continued opioid use.
Opioid side effects may deter a person from returning to work. Guidelines have been implemented to discourage the use of opiates beyond a limited time period.
Why the study matters:
Opioid medication such as morphine is used to relieve pain. These drugs have become more accepted for managing acute pain.
Opioids are effective but common side effects include:
- Sedation;
- Reduced alertness;
- Confusion; and
- Dizziness.
What the study involved:
The researchers studied 8443 people who filed workers’ compensation claims for new onset low back pain. Patients were divided into groups depending on the amount of opioid drug they received.
Outcomes that were studied included:
- Disability duration;
- Medical costs;
- Later opioid prescriptions; and
- Lower back surgical procedures within 2 years.
Variables such as age, gender, job tenure and injury severity were taken into consideration when calculating results.
Summary of study findings:
The study found higher opioid doses were associated with longer disability.
People receiving higher doses of opioid early on have:
- Higher medical costs;
- Prolonged disability;
- Higher risk of surgery; and
- Continued use of opioids.
The researchers believe that opioid side effects may contribute to prolonged disability. Reduced alertness and confusion may deter employees from returning to jobs requiring vigilance and use of mechanical equipment.
‘The Agency for Health Care Policy and Research’ established guidelines discouraging the use of opiates beyond a limited time period.
Original research:
Relationship Between Early Opioid Prescribing for Acute Occupational Low Back Pain and Disability Duration, Medical Costs, Subsequent Surgery and Late Opioid Use
Webster BS, Verma SK, Gatchel RJ.
Spine. 2007 Sep 1;32(19):2127-32