Opioids should be reserved for specific cases of low back pain, with a stronger emphasis required on helping individuals discontinue their opioid use, as outlined by University of Sydney researchers.
Low back pain is a prevalent issue that impacts over 80% of the population at some stage in their lives. Best practices recommend maintaining an active lifestyle and, when feasible, avoiding potent pain medications like opioids.
Despite these recommendations, opioids such as oxycodone and opioid combination medications like paracetamol with codeine remain the most frequently prescribed treatments for low back pain in Australia. Recent studies indicate that 45.6% of all pain medications recommended by GPs for low back and neck pain in 2013/2014 were opioids, up from 40.2% in 2005/2006.
Benefits of opioids
An analysis conducted in 2016 on existing research revealed that standard doses of opioids offered limited pain relief for individuals suffering from chronic low back pain in the short term. However, higher doses did not result in significant improvements in pain management.
Opioid medications function by interacting with specific receptors in the body, initiating a series of reactions that include the reduction of neurotransmitter release, which transmits pain signals to the brain.
The sustained advantages of opioid-based pain relief remain uncertain due to the absence of clinical trials providing long-term data. While observational studies indicate unclear benefits in pain management from prolonged opioid use, they also highlight an increase in associated risks.
The specific impact of opioids on patients experiencing acute low back pain (pain persisting for less than three months) is yet to be determined, as no clinical trials have been conducted within this particular demographic.
Harms of opioids
Opioids pose a high risk of unwanted effects, such as constipation, dizziness, and nausea. Moreover, there are serious risks like dependency, leading to withdrawal symptoms upon cessation. These may manifest as anxiety, nausea, restlessness, sweating, vomiting, or abdominal pain, making it challenging to discontinue opioid use.
Additional severe risks involve opioid overdose and death. Shockingly, approximately 62 individuals in the United States succumb daily to prescription opioid overdoses. Notably, Australia has witnessed a surge in opioid-related fatalities in recent years, paralleling the uptick in opioid prescriptions.
Short-term back pain
Acute low back pain is typically not indicative of a serious underlying condition and usually resolves swiftly over time. It is crucial to maintain regular activity and steer clear of prolonged bed rest. Consider using a heat pack for alleviating pain, as additional treatments may not be necessary.
If medication is needed for pain management, seek advice from a doctor or pharmacist regarding suitable options. This might entail the short-term use of basic pain relievers like paracetamol or a non-steroidal anti-inflammatory drug such as ibuprofen.
Reserve opioids for cases of severe pain where alternative treatments have been ineffective and the benefits outweigh the risks. Your physician will evaluate your suitability for opioid therapy and provide guidance throughout the process.
If opioids are prescribed, utilize them for the briefest duration possible, at the minimal effective dosage, alongside non-pharmacological interventions like maintaining an active lifestyle. Discontinue opioid usage after the agreed-upon treatment period and promptly report any adverse effects to your doctor.
Chronic back pain
Low back pain lasting longer than three months requires a comprehensive approach for effective treatment. Avoid relying solely on drug therapies to improve your condition. Begin with non-drug interventions, such as targeted exercise routines and physiotherapy sessions.
Seek the guidance of a diverse team of healthcare professionals, including GPs, allied health experts, and medical specialists, to address the various factors contributing to your pain. Some treatment plans integrate physical exercises with cognitive behavioural therapy to reshape negative patterns of thinking, feeling, and behavior.
When medication is necessary, adhere to the same guidelines as for acute low back pain. If opioids are prescribed, ensure a structured plan is in place for tapering off and discontinuing their use, particularly if pain relief is not forthcoming.
Coming off opioids
Confidently consider transitioning off opioids if:
There has been no significant improvement in pain and function shortly after starting the medication, even with escalated doses.
You are experiencing unwanted side effects.
You observe early signs of overdose risk such as confusion, slurred speech, or work/family issues related to opioid use.
If you have been using opioids for an extended period, abrupt cessation may not be advisable due to potential withdrawal symptoms. Your doctor can assist you in gradually discontinuing the medication and can facilitate referrals to additional support services if necessary.
Long-term treatment strategies may involve opioid substitution programs like the methadone program, which are designed to stabilize dependency. These programs are available in select community pharmacies and hospitals. Your doctor will typically be able to organize a care plan tailored to your needs.
The road to discontinuing these medications is demanding but achievable. Rest assured, many individuals have experienced enhanced function without exacerbating pain while transitioning off opioids.
Â
This article was originally published on The Conversation and authored by Associate Professor Christine Lin, Dr Christina Abdel Shaheed, and Dr Stephanie Mathieson.
Comentarios