Opioids Recommended for Back Pain

Study: Controversial Drugs Deserve Consideration

From the WebMD Archives

Oct. 3, 2002 -- Potent opioid-based pain relievers should be considered in treating the millions of people who suffer from chronic low back pain, according to a new study. The researcher says the drugs' effectiveness is unquestioned, despite the controversy surrounding their use.

Opioids are pain relievers that are derived from the opium plant and include well-known medications such as morphine, Oxycontin, and Duragesic. Although the drugs are commonly used to treat cancer-related pain, they are seldom used to treat other chronic pain conditions. Low back pain is the most common type of chronic pain syndrome in the U.S.

Study researcher J.D. Bartleson, MD, neurologist at the Mayo Clinic in Rochester, Minn., says this widespread reluctance to prescribe the drugs for non-cancer pain is based on prejudice rather than scientific evidence. His study is published in the September issue of Pain Medicine.

"Although this is somewhat controversial in that the majority of physicians still have prejudices against the use of opioid [painkillers] for chronic pain, there is a place for their carefully considered and closely monitored use in patients with low back pain," says Bartleson, in a news release.

He says few clinical trials have examined the role of opioids in treating chronic low back pain, but those that have indicate the drugs ease pain in these patients.

"There appears to be a subset of patients for whom these medications provide substantial pain relief, improve quality of life, and restore ability to function on a day-to-day basis," writes Bartleson. "For some, this can mean the difference between working and going on disability."

The controversy surrounding the drugs is based on several issues. One of the most publicized is the risk of dependence and abuse of the drugs due to their habit-forming potential. Second, some people may develop a tolerance to the medications and need to increase their dose. Finally, the drugs can cause side effects such as nausea, constipation, sedation, and thinking impairment.

But Bartleson says his review of the research to date shows opioid use is associated with some moderate side effects, but not with long-term adverse effects, and the risk of drug dependence is low. In addition, research suggests that opioid dosage remains relatively stable over time, but more long-term studies are needed on this issue.

However, even though his research has made him "a believer" in opioids, Bartleson admits that he's still reluctant to treat his own patients with the drugs, which highlights the need for more studies on the use of opioids to treat non-cancer-related chronic pain conditions.

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