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Opioid analgesics provide equivalent relief to placebo for acute low back and neck pain

Using opioid analgesics for patients with acute low back or neck pain offers no significant pain relief advantage compared to placebo, according to a recent randomised trial.

The OPAL trial, recently published in The Lancet, investigated the efficacy and safety of a short course of an opioid analgesic for acute low back and neck pain. Patients with 12 weeks or less of low back or neck pain (or both), and of at least moderate pain severity, received guideline-recommended care plus either oral oxycodone (up to 20 mg daily) or identical placebo for no longer than six weeks. The primary endpoint was pain intensity at six weeks measured on a 0-10 scale.

Opioid use and pain scores

A total of 347 participants with a mean age of 44.7 years (51% male) were randomly assigned to either group, with 174 given the opioid oxycodone.

When assessed after six weeks, the mean pain score was 2.78 in the opioid group compared to 2.25 in the placebo group (adjusted mean difference = 0.53, 95% CI -0.00 to 1.07, p = 0.051). In fact, more patients in the opioid group had ongoing pain at weeks 26 and 52 than in the placebo group.

While there were no significant differences in pain relief, a similar proportion of participants in the two groups experienced at least one adverse event (p = 0.30).

The researchers concluded that there was no good evidence that opioids should be prescribed for people with acute non-specific low back or neck pain.

Clinical guidelines suggest that the use of opioid drugs in the management of acute low back pain should only be used in carefully selected patients and for a short duration. Despite this recommendation, an Australian study revealed how among 6,393 patients with a diagnosed lumbar spine condition, 69.6% received opioids. For general acute pain, IV paracetamol is known to provide similar relief to NSAIDs and opiates.